What is PTSD?
Healthcare is a dynamic, demanding and often unpredictable environment to work in. Depending on the specific job, health care workers can become exposed to psychosocial and physical hazards, including traumatic events. Traumatic experiences on the job, often seen in the healthcare sector, may lead to post-traumatic stress disorder (PTSD). PTSD is a mental health condition caused by witnessing or experiencing actual or threatened death, serious injury or violence. Being affected by these types of events and having some post-event reactions can be normal. However, if the thoughts or memories of these events start to persistently affect the life of the person long after the event, that person could be experiencing PTSD.
Impact on workplace health and safety
In 2017, there was a heightened focus on mental health in health and community care workplaces as a result of Workplace Safety and Insurance Board (WSIB) policy changes, allowing for coverage of Chronic Mental Stress claims, which took effect on January 1, 2018. Additionally, in late December 2017, the Government of Ontario announced that it would propose to include nurses in the Supporting Ontario’s First Responders Act, presumptive legislation for coverage related to PTSD. On May 8, 2018 the Ontario government passed an amendment to the Workplace Safety and Insurance Act (WSIA), 1997, making it easier for nurses and front-line healthcare workers to access WSIB benefits for PTSD specific to work-related trauma events.
Like first responders, front-line nurses are likely to suffer from PTSD because they have a greater potential to be exposed to traumatic events. With the new proposed presumption, once a front-line nurse is diagnosed with PTSD by a psychiatrist or a psychologist, the claims process for WSIB benefits will be expedited, and nurses will not be required to prove a causal link between PTSD and a specific event.
Canadian research on PTSD among nurses estimates prevalence rates as high as 40 per cent. This number can potentially be higher as the system continues to evolve and make PTSD more recognizable and reportable for workers.
What are some of the measures employers can implement now to prevent and respond to PTSD in their workers?
Although the vital discussion about PTSD in workers has begun and a number of efforts are underway to develop tools and resources, there is still much work that needs to be done in this area. From what is known to-date, here are some of the steps that employers should consider to protect their workers’ psychological health:
- Primary Prevention
Employers have a legal duty under the Occupational Health and Safety Act to assess the risks specific to this hazard and notify the worker of its existence. Hence, employers need to recognize the hazard and assess the risk of being exposed to trauma in their workers. As a next step, employers need to put controls in place to protect workers based on the results of the risk assessment. In general, organizations who engage in proactive primary prevention should develop a prevention program specific to psychological health and safety that will include an element of PTSD (primary) prevention as well as appropriate post-incident response.
One example of primary prevention is resiliency training. Resiliency training should include an overview of what resiliency is and why it matters, how resiliency is related to prevention of PTSD, information for reducing arousal symptoms, techniques for managing distressing emotions, and preparing for a crisis. Additionally, understanding the risk factors, such as severity of exposure, should be included in training.
- Peer-support programs to prevent PTSD in nurses
Peer-support programs are becoming particularly common in organizations with high-risk of exposure to traumatic events. Although the evidence to show its efficacy is still limited organizations and workers who have this active in-house resource report very positive feedback. Overall, there seems to be a benefit to having access to an individual within the organization who is skilled and knowledgeable in trauma counselling.
Resources such as the in-house peer-support program, should be part of a larger, organization wide strategy and prevention plan with a specific focus on addressing post-traumatic stress injuries. The recent change in legislation is a step in the right direction that not only acknowledges the importance of helping workers who have been diagnosed with PTSD, but also the need to develop and implement prevention plans to protect the health and safety of workers who may be at risk. Psychologically healthy and safe workers are essential for quality patient care, successful functioning of an organization and a strong health care system!
The prevention system partners are working together to better understand work-related trauma injuries and identify some effective tools to help workers. One example is a current research project that is looking at trauma experiences in psychiatric workers. Any questions can be directed to the project team contact, Kayla Sherborn firstname.lastname@example.org
PSHSA has been working on supporting front-line workers, with the following tools and resources:
PTSD Fact Sheet
Provides information about PTSD and the development of PTSD Prevention Plans including prevention, intervention and recovery and return to work. The site includes organizational assessments, sample policies and links to resources. It also includes research and news related to PTSD. View submitted PTSD Prevention Plans on the MOL Website.
Provides information about PTSD and links to resource and tools including prevention, intervention and recovery and return to work sample policies and procedures, news and research: www.firstrespondersfirst.ca
Is a joint effort from Ontario’s Health and Safety System Partners to provide business owners with resources needed to support positive mental health prevention efforts.
An evidence based tool to assess psychosocial factors in your workplace.
This guide and resource kit will provide workers a basic understanding and a place to start to learn about workplace stress and what to do about it. The guide gives definitions, common causes of mental distress, legal frameworks (focusing on Ontario), possible actions to take, and resources available. It is an introduction and action guide created by workers for workers.
Although the current available resources focus on first responders, there has been ongoing discussion and a plan to build a resource dedicated to PTSD in nurses. This will be in development over the next few months and will be disseminated through PSHSA to all stakeholders.
Olena Chapovalov, RN, BScN, BSc, MPH is a Regional Consultant, Health & Community Services, Public Services Health and Safety Association.
 Guay S, Tremblay N, Goncalves J, et al. Effects of a peer support programme for youth social services employees experiencing potentially traumatic events: a protocol for a prospective cohort study. BMJ Open 2017;7:e014405. doi:10.1136/ bmjopen-2016-014405