In June 2020, I was bemused to hear I’d been nominated to become a TRiM manager for my trust. What did that mean?
I learned TRiM was short for trauma risk management — a peer support system that helps staff who have been exposed to trauma cope with adversity.
I was anxious. As a pharmacist, my practice was aligned to the slightly more sedate specialisms, and trauma was not among my expertise.
Like many raised in the NHS, I’ve seen the birth (and demise) of a fair few well-meaning initiatives, but I can’t deny I was curious on this occasion and I spent a weekend researching the TRiM system.
The system sees peers in the organisation take formal actions, at specific times after the event, to support the person who has experienced trauma. These steps involve identifying the acute stresses that may occur in the aftermath; conducting a confidential risk assessment with the individual to encourage them to talk through their actions before, during and after the event; providing support and modifications to their working pattern, if necessary; and catching up four weeks later to see how things are going.
I found the system to be underpinned by strong, evidence-based research into the management of psychological trauma, and psychological resilience, in organisational settings.
The system has been used by the military to counter post-traumatic stress disorder (PTSD), and now other organisations are harnessing its benefits. In fact, my four-day training was delivered by an ex-Royal Marine, a pragmatic man who challenged our approaches and inhibitions, while reminding us that our practice as TRiM practitioners should not be clouded by our professional preconceptions.
There is little overlap between trauma practice and pharmacy practice, so I felt safe that my professional expertise would not interfere. The psychologists on the course, however, were reminded to avoid focusing on the individual’s feelings during the TRiM interviews; chaplains were also asked to keep theology at bay; and clinicians were discouraged from making a diagnosis.
I was interested to discover that my fellow TRiM managers were psychologists, and one a principal specialist from the occupational health department. I marvelled at their immense professional experience, but they very quickly concluded that I was the most systematic of us, owing to my attention to detail and affinity for process — a typical pharmacist!
Throughout the course, we were presented with scenarios, such as aircraft disasters, properties consumed by fire and terrifying explosions amid conflict. I wondered how any event at our trust could be as traumatic as this, apart from those very rare major issues, but this is where TRiM’s strength lies: the risk assessment is guided by an individual’s context.
For example, imagine a patient has assaulted a staff member. This patient has dementia and they have thrown their bedpan, and it has hit a staff member. We empathise with all involved, and follow trust process and clinical guidelines for treatment to prevent a reoccurrence. The staff member is ‘debriefed’ by a manager in respect of what went right, and what did not. The staff member may continue the shift or perhaps they require sickness absence. But would we respond differently if, say, we knew that staff member had been a victim of domestic abuse? The bedpan could trigger negative feelings from prior adverse experiences.
The past year has made understanding trauma at work more important than ever. The COVID-19 pandemic exposed healthcare professionals to stressful situations and risk of infection, all while isolated from their family and friends. Many staff caring for the most severe cases in the first wave of the pandemic were left traumatised by their experiences. A colleague of mine was redeployed to critical care but returned to her base ward because of acute insomnia. Another, a consultant in the intensive care unit, made a light remark about his PTSD which, ordinarily, might have been met with a knowing response, but on this occasion, it was met with a poignant silence.
I worry about this being ‘the norm’. Understanding TRiM, however, has realigned my practice, and I am now making valuable contributions to the wellbeing of staff in our organisation to change this.
All healthcare professionals should learn about trauma and how it can be managed, and organisations should help them do this. The COVID-19 pandemic has brought staff wellbeing into sharp focus and their trauma may not necessarily lessen with time. Our workforce is precious and, in response to the pandemic, organisations must take robust and considered action now.
Darashna Moodley, pharmacy site lead and medicines information, University Hospitals Coventry and Warwickshire NHS Trust