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Le stress traumatique secondaire et la fusillade d’Ottawa

Le stress traumatique secondaire et la fusillade d’Ottawa : Qu’arrive-t-il après notre retour à la vie de tous les jours?

Ottawa war memorial

Click here to read in English

Plusieurs personnes ont été directement touchées par les évènements d’Ottawa la semaine dernière – les plus bouleversés, bien entendu, étaient la famille de la victime, les proches du tireur, les bons samaritains qui se sont précipités au secours du caporal Nathan Cirillo, le personnel médical d’urgence et les policiers qui ont agi sur la scène du crime, tous les individus à l’intérieur du Parlement qui ont été témoins de l’affrontement armé, ainsi que tous les autres qui se trouvaient sur la Colline : ceux qui ont passé des heures en confinement, les touristes et passants qui ont assisté à l’attaque, les médias et un tas d’autres gens que j’oublie probablement. Certains de ces individus ont été directement exposés à un traumatisme, alors que d’autres ont expérimenté une forme plus indirecte d’exposition traumatique.

En s’éloignant de l’épicentre de la tragédie, on peut établir une liste d’autres individus qui ont été profondément bouleversés par la fusillade – des citoyens d’Ottawa, des Canadiens qui l’ont regardée aux nouvelles, et bien sûr la communauté globale. Ces gens n’ont pas été en contact direct au traumatisme, mais ont potentiellement secondairement été traumatisés tout de même : si vous avez regardé une partie des séquences non censurées diffusées sur les écrans télévisés à peine quelques minutes après la fusillade, vous aurez peut-être remarqué des images assez graphiques et troublantes centrées sur la victime. J’ai remarqué qu’alors que la journée avançait, la séquence montrée en boucle était altérée afin de masquer quelques-uns des éléments les plus perturbants de la scène. (Vous ne l’aurez peut-être pas remarqué, mais il y a que je dispose d’un radar pour l’exposition traumatique dans la sphère publique et la manière dont elle est faite. Appelons ça ma propre mission et obsession personnelle.) Cependant, avec Youtube et des douzaines de passants capables de filmer la scène avec leurs téléphones intelligents, il ne sera pas difficile de trouver des images non censurées quelque part sur le net, en cherchant bien. Je ne suis pas certaine de pourquoi la presse a décidé d’arrêter de montrer les détails les plus graphiques – était-ce par respect pour la famille de la victime ? Une décision pour épargner les téléspectateurs ? Peut-être un peu des deux, et c’est là une bonne chose. Dommage que cela n’arrive pas plus souvent.

Heureusement, notre degré de compréhension du stress traumatique s’est considérablement amélioré au cours de la dernière décennie – la plupart des gens sont maintenant familiers avec le concept du Trouble du Stress Post Traumatique (TSPT) et n’ont pas de difficulté à comprendre que ceux qui se trouvaient au centre d’évènements comme la fusillade d’Ottawa puissent être considérablement affectés durant les semaines et peut-être même les mois à venir. Nous savons aussi que certaines personnes sont plus vulnérables aux facteurs traumatiques de stress et peuvent développer de la détresse psychologique à la suite d’un tel événement : l’intensité de la réaction d’une personne est déterminée par l’existence chez elle d’un passé traumatique, d’un passé de troubles  psychologiques ou de dépendance, par la personnalité de l’individu et ses modes d’adaptation, par sa recherche de soutien adéquat après l’événement traumatique, par la qualité du support offert par son groupe social et par plusieurs autres facteurs.

Une chose est claire – lorsqu’on vit un événement traumatique, beaucoup ressentent un fort besoin d’en parler avec les autres. C’est une très bonne chose. Parlez, écrivez, partagez avec vos proches, avec vos collègues de travail et vos amis. Ce besoin de se rapprocher et de raconter son histoire peut aussi arriver lors d’événements intensément heureux – parlez à une nouvelle mère de son histoire d’accouchement quelques heures ou quelques jours après la naissance, et elle vous racontera minute par minute chaque cube de glace qu’elle a mâché et à combien de centimètres de dilatation elle était. Parlez-lui en un an plus tard, et elle vous racontera, en bref, que « ça faisait horriblement mal et que ça a duré 26 heures », et, à moins que ç’ait été un accouchement très traumatisant, elle ne ressentira plus le besoin de partager minute par minute un rapport de ce qui est arrivé. C’est tout à fait normal. Avec des événements traumatisants impliquant un acte criminel, le besoin de partager le traumatisme expérimenté peut être plus fort. Un « acte de Dieu » est très différent de la décision délibérée d’un individu de faire du mal à d’autres, même si l’auteur du crime est profondément troublé psychologiquement. Alors parlons-en, absolument.

Cependant, on devrait prendre soin de partager ce qui est nécessaire plutôt que « tous les détails sanglants » à moins que ceux-ci soient tout à fait centraux à notre expérience. Après les événements du 11 septembre 2001, le Globe and Mail (ainsi que plusieurs autre médias) a partagé des photos incroyablement graphiques que je ne serai jamais à même de retirer de mon esprit – j’était traumatisée par ces images et ce n’était pas nécessaire – je n’avais pas besoin de les voir pour être compatissante et profondément ébranlée par l’écroulement des tours jumelles. Quatorze ans plus tard, ces photos du 11-Septembre me hantent toujours lorsqu’il est question du World Trade Centre. Il en est de même pour le procès Bernardo, quelque vingt ans plus tard.

Alors que les événements d’Ottawa s’estompent, certains d’entre vous resteront peut-être très ébranlés et très affectés par les sons, images et émotions en lien avec la fusillade. Si, dans plusieurs semaines, vous êtes plus chamboulés que vous ne le devriez – si vous êtes plus bouleversé(e) que vos collègues, si vous avez de la difficulté à dormir ou à vous concentrer sur autre chose, si vous expérimentez des images intrusives ou des cauchemars – allez chercher de l’aide. Prenons soin les uns des autres.

Quelques ressources utiles : 

Association Canadienne pour la santé mentale:

Obtenir de l’aide 

Le trouble de stress post traumatique

 

Photo: Michel Loiselle 

©Françoise Mathieu 2014      www.compassionfatigue.ca

Secondary Traumatic Stress and the Ottawa Shooting

Ottawa war memorial

Cliquez ici pour lire l’article en francais

Many people were directly impacted by the events in Ottawa last week – most affected, of course, was the victim’s family, the perpetrator’s loved ones, the good samaritans who rushed to Cpl Nathan Cirillo’s help, the paramedics and police officers who responded to the scene, all of the individuals inside the Parliament building who witnessed the gun fight, and everyone else who was on the Hill: those who spent hours in lockdown, the tourists and passersby who witnessed the attack, the media and a whole host of other people I am probably forgetting. Some of these individuals were directly exposed to a trauma while others experienced a more indirect form of traumatic exposure.

As one moves away from the epicentre of the tragedy, we can list millions of other individuals who were deeply affected by the shooting – Ottawa citizens, Canadian viewers who watched it on the news and of course the global community.  These folks were not exposed to direct trauma, but were potentially secondarily traumatized all the same: If you watched some of the raw media footage which was shown on our TV screens minutes after the shooting, you may have noticed some very graphic, rather disturbing images centered around the victim. I noticed that as the day progressed, while the footage was being shown in a continuous loop, it was slightly altered to mask some of the more disturbing elements of the scene.  (You may not have noticed that, but I have a homing device for trauma exposure in the public sphere and how it’s done, call it my own personal mission and obsession). However, with YouTube, and dozens of passersby able to film the scene with their smart phones, it won’t be hard to see that raw footage somewhere on the net, if one looks hard enough. I am not sure why the media outlets decided to stop showing the more graphic details – was it out of respect for the victim’s family? A decision to spare the viewers? Maybe a bit of both, and that’s a good thing. Too bad it doesn’t happen more often.

Thankfully, our degree of understanding of traumatic stress has significantly improved over the past decade – most people are now fairly familiar with the concept of Post Traumatic Stress Disorder (PTSD) and have no difficulty understanding that those at the centre of a tragic event like the Ottawa shooting might be significantly affected for weeks and perhaps months to come. We also know that some individuals are more vulnerable to traumatic stressors and may develop more significant psychological distress as a result of this event: the severity of the reaction is determined by a prior trauma history, a history of mental illness or addiction, a person’s personality and coping styles, whether or not they were able to seek good quality debriefing afterwards, the quality of their social supports and several other factors.

One thing is clear – when we experience a traumatic event, many of us have a strong need to talk about it with others. This is a very good thing. Talk, write, share with your loved ones, with your work colleagues and your friends. This urge to connect and tell our story can also happen to us during very intense happy events – talk to any new mother about her birth story hours or days after the delivery, and she will give you the play-by-play of each cube of ice she chewed on and what centimetres of dilation she was at. Talk to her again a year later, and she will likely tell you, in a nutshell, that “it hurt like hell and took 26 hours” but unless it was a very traumatic birth, she will no longer need to share minute by minute account of what happened. This is completely normal. With traumatic events that involve a criminal act, the need to share and the trauma experienced may be more potent. An “act of God” is very different from one human being’s deliberate decision to cause harm to others, even if the perpetrator is deeply psychologically troubled. So let’s talk about it, absolutely.

However, we should take care to share what is necessary vs “all the gory details” unless those are extremely central to our experience. After 9/11, the Globe and Mail (and many other news outlets) shared some incredibly graphic photos that I will never be able to remove from my mind – I was quite traumatized by those images,  and there were not necessary – I did not need to view these to be compassionate and profoundly distressed by the collapse of the Twin Towers. Fourteen years later, those photos of 9/11 still haunt me whenever I hear mention of the World Trade Centre. The same is true for the Bernardo trial, some 20 years later. Click here to read more about “Low Impact Debriefing”

As the events in Ottawa recede, some of you may remain greatly shaken and very affected by the sounds, images and emotions surrounding the shooting. If, a few weeks from now, you feel that you are more distressed than you should be – maybe you are more upset than your colleagues, are having difficulty sleeping or focusing on other things, perhaps you are experiencing intrusive images or nightmares – please seek some support. Let’s take good care of one another.

Helpful Resources: 

Canadian Mental Health Association: Getting Help

CMHA Website on PTSD

© Françoise Mathieu 2014

Photo credits: Michel Loiselle 

Resolving Family Caregiver Conflict

In the Fall issue of the Family Caregiver News Magazine: our very own Meaghan Welfare on “Resolving Family Caregiver Conflict”

family caregiver fall

Click here to download and read this article.

 

 

 

 

Calling all Champions: Delete!

by Alexandra Fortier, MSS, RSW

“Calling all champions” is a new column this Fall, whose aim is to stimulate conversations, get “shelved” projects started and to make your ideas happen. Basically, the intent is to get your fire started and to get your inner champion moving!  This is the second article in the “Calling all Champions” series.

eraser

My kids and I have a weird thing where they ask me: “Who’s the best mom in the world?”… and they always hope that I’ll answer: “It’s me”. But I can’t… not because I don’t feel like I’m a good mom, but because I truly believe that my mother is the best mother in the world! Let me explain why I feel like this.

Among many qualities my mom has  - she doesn’t sweat the small stuff; she loves unconditionally; she’s the most flexible person there is… and that’s just to name a few, she taught me one of the most important life skills I have to date, and she didn’t even mean to do it.

When I was around 14 years old, I was very self-deprecating. I would constantly say things like: “I know, I’m irrelevant”. Until one day, my mom very calmly told me to not just to stop talking about myself in that way, she told me to erase it! At first, I didn’t quite get it, but every time I would say something negative about myself, there she was, saying: “Say DELETE”. To humour her, I would say, “delete” out loud (with a bit of an eye roll for good measure). Her idea behind this was, if you say something about yourself enough, you’ll end up believing it. Funny thing is that after a while, I didn’t need my mom to remind me to “delete”. I would catch myself saying negative things about myself and would instantly say, “delete”. It got to a point where I was even erasing negative thoughts… I was now mentally saying, “delete”.

Why is this important you might ask? Well it’s quite simple – my mom’s intuition was right. If you register that you are a certain way, it will become the perception that you have of yourself, and that’s how you’ll act. You will then be the number one person who will be limiting you to achieve your dreams.

Imagine this if you will: In your brain, you have a tape recorder (I know, very vintage) and it’s highly sensitive to negative talk (your own or others). Once the tape is full, your brain will replay it over and over again. You then become the #1 person that gives you negative talk (even if the initial message came from someone else). But what’s great about vintage technology is that you can press stop on the tape and re-record a new message on it.

So my challenge to you this month is to listen to what your tape is telling you: Is it positive? Great! Pass the positivity around! Is it negative? Great! You’ve achieved the first step already, recognizing what, when and how many times you are speaking negatively about yourself. Now is the time to press the stop button. How? Say, “delete”. Once it’s become second nature, consider the situation and try to replace your negative thought with a realistic one. For example, you overcooked your dinner and you instantly say something depreciative of yourself – DELETE – Now re-record something realistic like, WOW I must be distracted to have overcooked the pasta. By doing so, you’re creating a new mixed tape!

What’s great about “delete” is that it’s a life skill – it’s surprising to see how it can be used everyday. I still use it for myself, it keeps me in check, and I’ve now passed this knowledge along to my kids.

So, what do you think? Are you ready to hit “Delete”?

 

The 1% Change Challenge

by Alexandra Fortier, MSS, RSW

“Calling all champions” is a new column that has the very transparent and direct objective to stimulate conversations, get “shelved” projects started and to make your ideas happen. Basically, the intent is to get your fire started and to get your inner champion moving! The column will be presented every month with various themes. I hope to help stimulate you and bring out your healthy competitive side to make things happen!

folded laundry

Change can be a scary thing. Depending on the situation, it can create anxious feelings of “What will happen?”, “Will I know anyone”, “What if’”… Which is why most people prefer status quo. The “Let’s not change anything; let’s keep our old habits” attitude.

However, the reality is, not only is change good, but it’s unavoidable. A great example of positive change is that of reading a book. Let me explain. If I were to pick up a book at the library and stare at the cover for 3 weeks, that would be the equivalent of “the no change” attitude. But, as soon as I turn a page, that is change. Even if you are one of those readers that read the end part first to avoid surprises, it’s still a “change” attitude.

Granted, reading is a habit that most of us don’t consider a change, because it’s already a developed habit. What is the most difficult thing to do is change something that is opposite or different to what you are currently doing. I can name many, namely changing your: sleeping habits, eating habits, exercise habits, spending habits, and on, and on, and on.

When you think of it that way, it becomes easily overwhelming and will bring you back to the “let’s keep our old habits” attitude.

Which brings me to the 1% change. This isn’t a new concept. It’s merely thinking of what you wish to change or achieve, then taking small, non-threatening, steps to creating that change and thus, changing your habits.

I’ll give you an example: 4 years ago, I listed out what my day looked like (responsibilities, chores, work, family…) and I decided on ONE thing that bugged me most, then I applied the 1% change concept. Here’s what I did.

I chose folding laundry… it’s not that it’s difficult, it’s just… I HATE it. Hum… what could I do? That’s when I came up with a win-win situation idea! I have 2 kids. At the time, they were 8 and 5. Every Saturday morning they watch cartoons… AND when we go out, they would always ask me to buy them something… So I put them to work. While they watch their cartoons, they “fold” the laundry. And because they do this small chore, I give them $5 allowance per week.

Here is the win-win: I no longer fold laundry. I developed a healthy “let it go” attitude (because the folding technics of a 5 year old is cringe worthy-but I didn’t redo their work… now they are experts!). They are happy because they get a little spending money every week. And the bonus that I didn’t think about is now they learned about the value of money. They save up for larger items and they don’t bug me in the store anymore (because if they ask, can I have this, I reply: “Sure, do you have enough money?” Which makes them think twice about the said item, and most often than not, they choose to not purchase the article in question).

The 1% Change Challenge – What will you do this week?

So here is your challenge: think of what you would like to change, then take a small step towards achieving this.

Post your ideas and achievements to inspire others to do the same!

 

Thank a helping professional today

“Listening can be an act of social justice” beautiful, inspiring, a call to action

https://www.youtube.com/watch?v=1I1mFSoTF1A&app=desktop

How long will you live? The link between Poverty and Health

Does it make sense to prescribe diaper cream to a baby with a chronic rash, when the real cause of the problem is that his mother can’t afford to buy diapers and change him regularly?

This is a fascinating show on the connection between poverty, health and life expectancy on CBC’s “Project Money”.  It features Dr Gary Bloch, a family doctor with St. Michael’s  Hospital in Toronto who is also the chair of the Ontario College of Family Physicians’ Committee on Poverty and Health.

Click here for the podcast

Dr Bloch is also the author of a March 20, 2013 Globe and Mail article entitled: “As a doctor, here’s why I’m prescribing tax returns. Seriously”

In this piece, Dr Bloch writes: “The link between health and income is solid and consistent – almost every major health condition, including heart disease, cancer, diabetes, and mental illness, occurs more often and has worse outcomes among people who live at lower income. As people improve their income, their health improves. It follows that improving my patients’ income should improve their health.”

This is an important discussion that we all need to be part of. It also suggests that front line workers, physicians, nurses, social workers etc. should always ask about a patient’s financial situation and become more aware of the resources available in the community.

Dr Bloch also believes in advocating for larger scale societal changes: ”As doctors we need to, and we can, prescribe income while advocating for real, effective policies to combat poverty.”

How refreshing and inspiring!

Book Review: Bringing it Home

9780771080005

Tilda Shalof is a Toronto-based ICU nurse who combines critical care nursing with a very successful writing career. Shalof has authored more than five books, including the best-seller A Nurse’s Story.  All of her books explore an aspect of nursing, from critical care to camp nursing to being a cardiac patient herself. I have often found myself devouring her latest work in a single sitting as her writing is conversational and very engaging.

In her most recent work, Bringing it Home – A Nurse discovers health care beyond the hospital, Shalof was commissioned by the Victoria Order of Nurses (VON) to take a tour of some of the home care services they provide across the country. This fascinating and sometimes poignant road diary left me in awe of these invisible and unsung nurses who work with the most neglected members of society. Shalof herself begins the book by candidly confessing that at first, she lacked enthusiasm for this assignment and had to be convinced to take it on. I mean, let’s be honest, for an ICU nurse, home care nursing is not high up on the list of sexiest jobs! But over time, Shalof’s eyes are opened and she concludes her road trip with a new appreciation for the crucial role these nurses play in supporting all of us, at one point in our lives.

Shalof contrast what she sees daily in hospitals to what she witnessed in home care:

There are so many things that still make no sense to me in the hospital. like the waste we create and the excessive use of technology; the restricted visiting hours and the no-pet policy. The fact that patients aren’t invited to participate in team rounds about their own care. Why aren’t people allowed – no, encouraged, to read their own charts? [...] Why are there nurses and doctors who don’t talk kindly – or at times even courteously – to patients, or who can’t find it in themselves to sit down and simply listen to what the patient has to say? [...] Why is there so much waiting in hospitals, and if you do have to wait, why can’t someone come out and tell you why and how much longer you’ll still have to wait, and maybe even do it with a smile? [...] in all of my travels outside the hospital, in all of my visits to homes, clinics, community centres, I saw patient care that was governed by logic, fairness and common sense, administered with kindness and goodwill – not to mention fiscal responsibility and restraint. More please.

This book presents a stark account of the realities of ageing for some many patients who do not have money, or family to care for them. It also highlights a whole host of skills and duties that most of us would not associate with VON: street outreach, pregnancy support, drug and alcohol support and many other invisible acts of kindness and assistance.

Kudos to Tilda Shalof for showing us the beautiful side of these talented, compassionate nurses.

 

Fall 2014 Workshop for Managers: Guide to Stress, Burnout and Trauma in the Workplace

Growing Volume of Work…More Complex Cases…

Shrinking Budgets…Overwhelmed and Stressed-Out Staff…

What can you do, as a manager?

overworked businessman

Develop strategies to address STRESS and TRAUMA in your workforce

Join us for 2 days of hands-on, concrete tools for Managers working in High Stress, Trauma-Exposed settings 

An intensive 2-day program with Dr Patricia Fisher, R.Psych., L.Psych. Canada’s leading expert in trauma-exposed environments.

September 23-24, 2014

9:00am-4:30pm (registration 8:30am)

Royal Botanical Gardens, 680 Plains Road West, Burlington, Ontario.

**Spaces limited to 25 participants – register early**

Click here for more information

CLICK HERE TO REGISTER

Click here to download Flyer

 

Brought to you by Compassion Fatigue Solutions

Summertime reads, recipe and an invitation to stay in touch

watermelon

Here’s a quick post for you today with three items: new reads, a recipe and an invitation…

It’s finally summer!  This is hopefully a time for you to slow down a bit, enjoy the beautiful weather, have a picnic, maybe go to a local market or outdoor music festival on your day off.

June was a very busy time for me, starting with the wonderful Care4You conference (photos will be posted next week!), a work trip the Florida Panhandle,  and a trek to England to visit family and friends.

Needless to say that by July 1st, I felt the need for a little r&r after all of this excitement.

Whenever I finish a hectic time and need to refuel, I try to go back to the basics: get more sleep, eat more greens and less carbs, ditch the caffeine and get more exercise. Those simple things help keep me grounded, and when I go too long without them I start feeling tired, unwell and irritable. So I went back to read my favourite healthy eating blogs and spent a bit more time in the kitchen juicing and making homemade meals. I came across this weird and wonderful gluten-free bread recipe that I will share with you below. There are also some newly published compassion fatigue articles to recommend, for your time in the hammock!

1) New Reads on Compassion Fatigue

I just had two new articles published and a book chapter which I co-wrote with my colleague Leslie McLean from Capital Health Cancer Care, in Halifax.

For Family Caregivers: When the Juggling Act Isn’t Working: 5 Key Strategies to Reduce Compassion Fatigue and Burnout. Click here

For nurses: Occupational Hazards: Compassion Fatigue, Vicarious Trauma and Burnout. Click here.

New Book Chapter: Managing Compassion Fatigue, Burnout and Moral Distress in Person and Family Centered Care Click here

 

2) Healthy Eating, Cool Gluten-Free Bread Recipe

If you read this blog regularly, you’ll know that I am a big fan of healthy eating and enjoy reading food blogs for pleasure. My two current favourites are Choosing Raw by Gena Hamshaw, a New York nutritionist, and My New Roots, a beautiful whole food blog by Sarah B. a Canadian who now lives in Denmark but recently spent 6 weeks in Bali (yes, I know, tough). What I like about these bloggers is that they propose easy, fresh recipes without dogma.

Sarah B. posted a crazy-sounding gluten-free bread recipe last year, called “The Life Changing Loaf of Bread” which may seem like a rather bold statement. I was intrigued, but did not have time to gather the ingredients to try it out until yesterday. Well, what a success! This produces a very dense, toastable seed bread. Not suitable for sandwiches but perfect for toasting. Fantastic! Click here for a the link to the recipe.

3)  Join the anti-spam brigade, and make sure you stay on our mailing list!

Finally, an important note to any of you on my mailing list. If you are a Canadian reader, you will likely have been deluged by emails lately from all sorts of businesses asking you to confirm that you wish to continue receiving their emails. A new anti-spam legislation became effective july 1st, 2014 and if you do not confirm your desire to receive emails from us, we will have to remove you to comply with the regulation. So please take a minute to click on the “confirm” button in the email we sent you recently.  Thanks!

Now, I’m going to go watch some tennis and World cup soccer and drink some romaine, cucumber fennel juice. (It sounds weird but it tastes great.)

Here’s wishing you a lovely summer!