Facilitating Health Professional Wellbeing Following Critical Incidents: An Action Research Study
The impact of critical incidents on health professionals and the lack of subsequent support is a concern for me, my colleagues, and the wider service we work in. The aim of this study was to explore how the development and evaluation of a support package could facilitate health professional wellbeing following critical incidents in National Women’s Health at Auckland District Health Board. A pragmatic approach underpinned the decision to use action research to collaboratively improve the support provided within the service. Through the project a critical incident eBook resource was created, evaluated and is now available for health professionals to use. This thesis, completed as part of the requirements for a Doctorate of Health Science, contains the story, reflections, findings and discussion of this action research study. The literature is extensive on the frequent occurrence of critical incidents in health care and the emotional impact these have on health professionals. The term second victim has been developed to capture the distress that can result following an incident, with the woman (or patient) being the first victim. Although the health professional’s despair is unlikely to be avoided the current literature does indicate that the response of colleagues and the organisation can make a difference to the level of distress. There is, however, limited guidance on what strategies work in the real world of the health system. Three action research phases were undertaken in line with Coghlan and Brannick’s (2014) model; Constructing and Planning Action (normally discrete, these were combined), Taking Action, and Evaluating Action. A core action group worked with me through cycles of experiencing (being attentive to the data), understanding (being intelligent), judgement (being reasonable) leading to action (being responsible). The data included organisational knowledge, group discussions, and interviews with health professionals. An initial eight interviews with health professionals were undertaken to hear their stories of what they found helpful following a critical incident. The themes from the interviews and following discussions provided chapter headings for the resource. The content was developed through multiple iterative cycles with subject experts. As part of the Evaluating Action Phase a further 11 health professionals were interviewed on the usability and the value of the tool. Changes were made and the final version was made accessible both nationally and internationally. In total 50 health professionals were involved in the creation of the eBook as a support package to facilitate wellbeing for themselves and colleagues. The characteristics of practical knowing proposed by Coghlan (2016) are used as a framework to present the study and shape the actionable knowledge produced in the study. The outcome was that there are four characteristics found to be guiding principles for the development and evaluation of a support package to facilitate health professional wellbeing following critical incidents with National Women’s Health. The characteristics are that: • Silence is broken on the everyday effect of critical incidents through the development of the support package; • Social construction of multiple realities within the organisation is reflected in the content of the support package; • Uniqueness of the service and the individual is captured in the support package through iterative cycles of action and reflection; and • Individual and collaborative concern for each other after a critical incident is present to create a support package that facilitates wellbeing. Complexity theory and social constructionism guided the study, assisting in each of the action research phases, revealing unconscious rules that health professionals used to guide their actions. The eBook makes visible the hidden assumptions health professionals have been making about how they should behave in the organisation, behaviours that in the past have created an unsupportive environment. The process of undertaking action research in my own organisation led to learning that contributes to the field of practical knowing and the value of making change through action research.