Gruppereaksjoner ved katastrofearbeid i sykehus

Abstract

The article deals with observed group reactions among survivors, relatives, and hospital staff participating in a crisis intervention program following a bus accident in Norway. The accident involved a group of Swedish schoolchildren (n=27) accompanied by teachers and parents (n=7). Twelve children and three adults died immediately, followed later by the death of the bus driver. The survivors and the dead victims were brought to the regional hospital. The groups gathered were thus the injured children and adults, the relatives of injured and dead victims, or both. The participating hospital staff were mainly members of the intensive care unit, staff from two surgical wards, and personnel from the psychiatric service unit. The group reactions observed were suggestibility and helplessness, a lack of autonomous functioning as individuals followed by group reinforcements of emotional outbursts and subsequently fight/flight reactions and intergroup rivalry, parallel to an idealization of the Norwegian crisis team. Similar reactions were to a lesser extent also seen among members of staff groups. There was a reduction in the hospital's capacity to maintain its ordinary treatment programs during the crisis intervention. A review of the literature shows that little has been published on the dynamics involved in groups of individuals undergoing mourning and crisis reactions, especially on how crisis intervention programs affect the hospital as a social system. Several theoretical models, particularly Bion's work on group dynamics and individual psychodynamic theory, are applied to explain the observed phenomena. Within these frames of reference major group reactions can be interpreted as individual and group regressions, collective projective identification, and group splitting phenomena. The reduction of the hospital work capacity may partly be interpreted as a result of the systemic hospital defence mechanisms being challenged by the crisis intervention program dealing with the emotional reactions in the open rather than suppressing them, as most hospital routines favour following individual crisis reactions. Planning for crisis intervention programs will benefit from taking into consideration the substantial group dynamics among any large number of individuals undergoing a crisis reaction.

Key Words:

• Crisis intervention
• Group procecces
• Post-traumatic stress disorder