Debriefing after Critical Incidents at Camp

Jeana Wilcox, PhD, RN, CNS, CNE

Camp is often associated with fun, friends, and nature. However, there are times at camp when very serious events occur that may take away from the fun campers and staff experience. Sometimes those events are so emotionally intense that an emotional debriefing is recommended. The purpose of this article is to identify aspects of incidents that may require debriefing in the camp situation, discuss differing approaches to debriefing individuals involved in the incident (i.e. campers, counselors, directors, site managers), and describe two specific tools that can facilitate effective debriefing.

Critical Incidents: What Are They and Why Is Debriefing Important?

According to Critical Incident Stress Management International, “critical incidents usually involve the perceived threat to one's physical integrity or the physical integrity of someone else. Most importantly, critical incidents are determined by how they undermine a person's sense of safety, security, and competency in the world” (CISM, 2010). Often defined as “crisis situations,” critical incidents are emotionally significant events. Because of the emotional nature of the events, debriefing is necessary. In relation to critical incidents, debriefing refers to therapeutic techniques used to assist a person in reframing the critical incident in a more positive manner, providing information, and analyzing feelings (Boyd, 2012; Regal & Roberts, 2002). Debriefing is often used in military situations to formally question a solider to obtain important mission information. In the camp setting, debriefing provides an outlet to assess potential risk management issues and potential emotional impact on those involved.

During a presentation of this information at the 2012 Association of Camp Nurses’ Symposium, several camp nurses shared critical incidents that have occurred in camps around the world. Examples of such critical incidents include: suicide attempt, health crisis of counselors or staff members (fainting, heart attack), campers threatening one another with weapons, camper self-amputation with a saw, natural disasters (tornadoes, flooding, and hurricanes), and near drowning. Though some critical incidents can be prepared for, other incidents are unexpected and emotionally ravaging to all persons involved. Debriefing needs to occur so persons involved may obtain the true facts about the situation, in contrast to the viral rumors that overtake camp; put the incident into perspective and honestly evaluate personal safety and security; and assist persons involved in developing healthy coping mechanisms.

Debriefing Needs at Various Developmental Levels

Campers and staff come to camp with varying levels of psychoso¬cial development. Developmental levels are important to consider when developing a debriefing plan for critical incidents. Campers and staff will range in age from school-aged children to adults.

School-aged children, in Erikson’s stage of Industry vs. Inferiority, need to feel a sense of self-confidence and thrive with recognition of their accomplishments (Boyd, 2012). During this stage, debriefing may be most beneficial if the nurse uses techniques such as art, games, and storytelling. It is important to acknowledge what each child brings to the discussion and instill in the child a sense of safety and security.

Adolescents, in Erikson’s stage of Identity vs. Role Confusion, need to feel secure in their sense of self (Boyd, 2012). During this stage, the nurse may be most effective by providing privacy and discretion when speaking to participants involved in the critical incident. It is vitally important to avoid communication styles that may be viewed as confrontational or accusatory by the teen. Adolescents need to know their viewpoint is valued while their emotional well-being must remain the priority of the interaction.

Adults, in Erikson’s Intimacy vs. Isolation or Generativity vs. Stagnations stages, need to feel secure in meaningful relationships with others and a sense of achievement (Boyd, 2012). Adults involved in critical incidents are most often in leadership and supervisory roles such as camp directors, counselors, or staff members. Feelings of guilt are very common for this developmental level. To help adults gain valuable knowledge in the aftermath of critical incidents, the camp nurse must help adults make sense of their relationship to campers and the critical incident. During the process, the camp nurse must help adults work through feelings of guilt while focusing on what has been learned and how to apply that knowledge to prevention or management of future incidents.

Asking All the Right Questions

Debriefing after critical incidents requires the camp nurse to ask the right questions. Not only is it important to obtain valuable information for risk management functions, it is also important to gain a clear understanding of the incident and potential impact it may have on the campers and staff involved. The table outlines important questions to ask during debriefing. This resource can serve as a guide to camp risk management personnel as they develop a written debriefing guide. Writing out a debriefing guide helps the administrator in charge stay focused during often emotional debriefing sessions (see Table 1).

Who

When determining who to debrief, asking who was involved in the incident is critical. The camp administrator or risk manager should ask who was involved, both directly and indirectly. Campers who are not directly involved but witness the incident will require debriefing and may be able to provide valuable information related to precipitating factors that lead to the incident. One must also determine who should be informed of the incident. Those who need to be informed may include cabin mates, counselors, camp or site directors, insurance company or legal representatives, parents, etc. Based on the information gained from answering all the “who” questions, the nurse must determine who will be debriefed and who should do the debriefing. The person doing the debriefing may be the camp nurse or another person trained in therapeutic communication techniques.

What

The camp risk manager must ask what occurred that led to the critical incident. Evaluating precipitating factors can help prevent similar incidents from occurring in the future. It is important to find out what happened before, during, and after the critical incident. Gaining input from multiple persons involved often helps fill gaps in the report. Different people may remember the incident differently. By debriefing everyone involved, a more complete picture of what happened emerges.

When and Why

Finding out when critical incidents occur and tracking that information can help in making programming changes that may prevent future incidents from occurring. Often times, critical incidents occur during periods when campers or counselors are low on energy or nutrients, during periods of limited supervision (“free time”), or when unfamiliar materials or equipment are being used. Pinpointing trends can lead to policies and procedures specific to high risk timeframes.

Where

Where did the incident occur? What physical surrounding factors may have led to the incident in question? For instance, in one Midwestern camp, a child went to the kitchenette, took a knife, and threatened another camper. What those involved in the camp failed to consider was the set-up of the cabin, normally used for all-adult groups. Items that were regularly used in this cabin were not protected prior to sleeping children in the cabin. Until the incident, no one had thought such a situation would occur.

How

The “how” of an incident often requires those involved to put together the Who, What, When, Where, and Why of the incident and develop a logical conclusion. Considering all the factors involved and rewriting policies or procedures can prevent future incidents from occurring or limit the damage if the incident can’t be prevented. During this stage of questioning, camp officials may develop a plan to communicate about the incident to camp stakeholders. It is often most beneficial to alert others to the situation and what is being done to remedy it rather than allowing second- or third-hand accounts to go viral in the virtual world we live in. Social media and connectivity of campers often lead to delicate handling of critical incidents.

Debriefing Tools

Tools used in debriefing may vary with the type of incident, age of those involved, and abilities of the camp nurse in psychosocial interventions. Reflective journals and group or individual debrief¬ing are some of the most common tools currently utilized. In the following sections, each tool will be briefly described. Additional information on each method is available from Critical Incident Stress Management International and a variety of online mental health resources.

Reflective Journaling

Reflective journaling allows all parties involved in the critical incident to evaluate the situation and their personal reaction to the incident. Hubbs and Brand (2005) describe reflective journals as “a mirror” into one’s heart and mind. Following a critical incident, there can be much conflict in both the hearts and minds of all involved. This tool allows people to put on paper what is in the heart and mind, put those thoughts away, and go back to reflect at a future time. Putting one’s thoughts into a reflective journal can release the brain and help with post incident difficulties such as anxiety, insomnia, and excessive worry. The key to using reflective journaling as a debriefing tool is to allow participants free reign on how the journal looks and whether or not to share the contents with others. For instance, young campers or more artistic persons may prefer to use drawings, art, and doodles; adults or more analytical persons may prefer narrative or timeline journals.

Group vs. Individual Debriefing

Debriefing involves the camp nurse or other qualified professional interacting with each person involved in the critical incident. Using Table 1, the person in charge of debriefing can ask questions to gain information and help everyone involved begin to mentally “work through” the impact of the critical incident. Sometimes these sessions are with individuals and sometimes in a group setting. Deciding whether to use an individual or group setting depends on several factors: age of individuals, how many individuals are involved, emotional distress of the individuals, and available support from other camp staff. Often times, in our technologically connected society, it is necessary to debrief more indirectly involved individuals before rumors become the accepted truth about a critical incident. A large group setting is ideal for conveying true information about the incident (protecting specific names and details as necessary) and often squelches the rumor mill from expanding so quickly. Likewise, depending on the nature of the incident, it may be necessary to provide parents and others outside the camp environment with truthful information about the incident and actions that are planned or have taken place as a result.
The key to debriefing after critical incidents is to be methodical; debrief everyone involved in the incident, directly or in a group setting; and return to ask questions and continue debriefing over several days or weeks if possible. Often times, emotions related to a critical incident take days to surface. As individuals begin to reflect and interact with others involved in the incident, different emotions may emerge.

References

Boyd, M.A. (2012). Psychiatric nursing: Contemporary practice. New York, NY: Lippincott Williams & Wilkins.

Critical Incident Stress Management International. (2010). What is a critical incident? Retrieved from www.criticalincidentstress.com/critical_incidents

Hubbs, D.L. & Brand, C.F. (2005). The paper mirror: Understanding reflective journaling. Journal of Experiential Education, 28(1), 60–71.

Regel, S. & Roberts, D. (Ed.). (2002). Mental health liaison: A handbook for nurses and health professionals. Edinburgh, England: Harcourt Publishers.

Wilcox, J. R. (2012). Debriefing after critical incidents at camp. Association of Camp Nurses Annual Symposium. Atlanta, GA.

Jeana Wilcox PhD, RN, CNS, CNE, is the associate dean for undergraduate programs and an associate professor of nursing at Graceland University in Independence, Missouri. She has been a mental health nurse her entire career. She earned a BA in psychology from the University of Missouri-Kansas City, a BSN from the University of Central Missouri, a MSN as an adult psychiatric clinical nurse specialist from the University of Kansas, and a PhD in education-curriculum and instruction from the University of Kansas. Wilcox is very active in camp nursing at Wilderness Retreat and Development Center in Lawson, Missouri.

 

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