The extent to which patients are willing to discuss traumatic events varies, as do their emotional responses. Feelings of fear, grief, anger, anxiety, worry, avoidance and guilt are common. It’s important to remain neutral and avoid expressing your views or opinions with patients. If the subject of tragic or violent events arises, refer to these tips to help navigate those conversations.
Actively listen by asking how the patient feels about the situation:
- Redirect the conversation from who is ‘right’ or ‘wrong’ to talking about feelings and how the patient has been coping with the event.
- Example: “It sounds like you have a lot of feelings about this. That’s expected.”
Ask if events have triggered memories of other situations or events:
- Memories may provoke painful emotions and negative behaviors (withdrawal, avoidance, hyper-vigilance or aggression) as ways to cope.
- Examples: “Have you found yourself thinking about things from the past?” or “Have you been in similar situations before?”
Avoid clinical, diagnostic and pathological language:
- You may see symptoms of psychiatric issues such as anxiety, depression or PTSD, but steer away from language implying a mental health diagnosis.
- Example: Instead of saying “That’s your depression talking,” say “Those kinds of feelings are normal.”
Communicate person to person rather than “expert” to “victim:”
- Use straightforward terms.
- Foster rapport and trust by expressing genuine concern rather than the expert position of treating them as a victim of an event.
- Examples: “This is a really difficult time. I wonder how this has affected you” or “How have you been coping with all of this?”
- Focusing on a patient’s strengths can promote long term recovery by helping patients adapt to traumatic events.
- The path to resilience varies from person to person.
- Example:” “Tell me about ways you have managed to get through other difficult times -- we can figure this one out too.”
Encourage patients to minimize their exposure to media coverage:
- Extensive media coverage can exacerbate negative emotions and serve as constant reminders of what happened.
- Place media coverage into context and remind patients that there are also positive things occurring in the world.
- Example: “Maybe you could use a break from all the TV news. How about turning off the TV and doing something else tonight?”
Understand your comfort level with talking about violent or traumatic events:
- Our emotions can be triggered by our work. Get help from co-workers or other practitioners to talk through your responses. Know your limits.
- Avoid discussing the situation, staff opinions or interpretation of the events in the presence of patients. This can inflame and evoke conflict.
- Find a trusted co-worker to share your feelings with -- away from patient areas.
Listen carefully to how patients are responding:
- Look for risky behavior, serious symptoms and signs of significant difficulty. Encourage patients to seek help after being discharged.
- For patients in crisis, share contact information for: