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CRITICAL INCIDENT DEBRIEFING

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Introduction

A critical incident is any event that consists of significant emotional power enough to overwhelm the usual coping methods. It may include a psychological or physical threat to the safety of the subject person or the community as a whole (Antai-Otong, 2001). A Critical Incident Debriefing is an integrated and systematic approach to handling and preventing further critical incidents. It  has become one of the most effective methods used to help understand current situations better and help plan for the future. It is a valuable tool designed to aid people that are experiencing psychological problems in order to produce better results in the future (Bonnel and Smith, 2010). This literature review shall, for this reason, deal with a case scenario of a critical incident and how critical incident debriefing can be conducted on the subject patient.

Critical Incident Debriefing

There are various existing models and methods of Critical Incident Debriefing. This review shall, however, use the Gibbs cycle for structured debriefing. The main reason for using this particular debriefing model is because it is accurate and clear, paving way for an easy description and analysis of the case scenario (Couper and Perkins, 2013). However, Ghaye and Lillyman (2006), state that the Gibbs cycle for structured debriefing is only ideal for adverse experiences. On the other hand, they also indicate that its incorporation of feelings, knowledge and action in one model, acts as its major strength.

The Gibbs model of Critical Incident Debriefing consists of six stages of the completion of one cycle, which helps in the improvement of the nursing practice for better service care in the future. The period commences with the description of the situation at hand. The second stage is the analysis of the patient’s feelings. The third stage is a comprehensive evaluation of the entire experience. The fourth stage is an analysis that is directed towards understanding and comprehending the situation. The fifth stage entails a conclusion that includes what could have been done to help the situation. The sixth and final step is the creation of an action plan that acts as a pro-active measure should the same critical incident occur again.

Case Scenario

A critical incident takes place in a psychiatric ward in the UK. During the evening, there are two separate cases involving the same patient. During both incidents, the patient injures members of staff.

Stage 1: Description

This is the stage that starts off with the introduction. The nurse should first introduce herself to the patient in order to reduce his or her anxiety, create a conducive climate and establish trust. The nurse should then proceed and ask the subject patient about the events that took place. No prior judgment should be made about the incident without the patient’s side of the story (Currey and Leslie, 2010). How the patient describes, the ordeal is essential for various critical inferences, such as the diagnosis, to be made (Dausey, 2005). The nurse should, for this reason, make an effort to explain to the patient the events that led to the debriefing. This is necessary since it is required of them as part of the code of professional conduct for nurses. They are required to give impartial, accurate and honest information in relation to the nursing.

Stage 2: Reactions, Thoughts, and Feelings

This is the stage where there is a changeover from the cognitive domain to the affective domain (Doherty and Digby, 2007). It enhances the stimulation of a coherent understanding.  Here the nurse or caregiver is expected to ask the patient general questions relating to the patient’s emotional and psychological status at the time of the commission. Questions such as “ What were your first thoughts?” are asked by the nurse as part of standard procedure. This is in an attempt to examine the mental status of the patient. The nurse should also ask the patient questions that will lead to what triggered the ordeal (Donnelly and Rowling, 2007). Questions such as, ” What irritated, you the most about this event?” should be asked by the nurse. According to Dorman (2008), such questions will help reduce tension and emotional involvement and enhance the nurse’s identification with the ordeal. It also enables the patient to gain perspective and a secure, speedy normalization (Dorman, 2008). The nurse is expected to explain to the patient the significance of this stage. This is because it is required of them by the code of professional conduct for nurses that they practice in accordance with the standards of the profession.

Stage 3: Evaluation

In this stage, the nurse gives a chance to the patient to make his or her assessment of the subject occurrence. The nurse should ask the patient what he or she considered right or wrong from the whole experience. Here the patient is expected to open up and give his honest opinion on the issue at hand (Furtado, Gergovich and Wild, 2010). This is necessary for the nurse to make the most accurate recording and consequently reliable inferences that are required of the nurses by their professional code of conduct.

Stage 4: Analysis

In this stage, the nurse does a comprehensive analysis. Questions regarding the issue at hand and previous circumstances that might have led to the latest occurrence are asked (Grice and Greenan, 2008). They enable the nurse get an overall picture of the patient’s behavioral patterns (Halpern and Tramontin, 2007). The patient is expected to bring in ideas from other personal experiences to help enrich the analysis. The patient makes comparisons of other people’s experiences and how they reacted, with the assistance of the nurse. The similarities and differences should be taken into consideration as they assist in the overall diagnosis.

Stage 5: Conclusion

At this phase the patient, with the help of the nurse, can make accurate conclusions based on the noted reactions, thoughts, feelings and analyzes that have been made in the previous stages. The patient should at this moment acknowledge and accept the inferences that have been raised by the nurse from the previous stages of debriefing (Haugen, 2008). Acknowledgment of the assumptions raised by the nurse marks a positive journey toward recovery.

Stage 6: Action Plan

According to Hunnicutt (2010), this is the most critical purposeful step in the whole debriefing process. It involves remedies, recommendations, and pro-active planning. This is the stage one formulates a plan to help him or her maneuver the same ordeal if it arises again (Jacobs and Coppes, 2012). In this particular case, the patient, with the assistance of the nurse should formulate various mechanisms that help one cope with the overwhelming emotions.

The nurse or the concerned hospital may formulate programs that help such patients. For example, restraint may be used to for a while to make sure that the patient’s and the staff’s physical safety is maintained (Kiekkas, Aretha, Stefanopoulos and Baltopoulos, 2012). Levine (2013) argues that restraint or seclusion may, however, be used when other less restrictive interventions have turned out to be ineffective to protect staff members and the patient from the potential harm. It is also imperative that the method or technique for restriction be the least restrictive intervention that will be effective to protect the staff members, the patient and others from the potential harm (Merino, 2011). If the restraint is to be used, it must be implemented in accordance with the appropriate seclusion and restraint methods determined by the hospital’s policy and State Law (Minden and Armantrout, 2006).

Critical Debriefing Skills

Various debriefing programs should be formulated especially in hospitals to help enhance the nurses’ debriefing skills. The facilitator plays a huge role in the success of debriefing for learning. For this reason, a theoretical account for adequate debriefing from the Advanced Life Support Group of the Resuscitation Council (UK) should be introduced (Murray, 2011). The authors have used this framework in nursing studies with irrefutable learning outcomes (Needham and Sands, 2010). Essential requirements include a teaching plan, setting the right mood for the learner, particular attention to the physical environment, executing a concise summary and closure and managing the dialog. Reeves (2004), states that, a learner’s contemplation of their deeds is key to their learning experience, being guided (not driven) by the facilitator.

However, as was noticed earlier, adult students learn in different ways. Debriefing in nurse education often utilizes task-based learning or skills related to the individual’s current knowledge or skill (Schenarts and Tyson, 2008). The educational literature suggests that debriefing may assist a low‑performing student by allowing revision and with that improve performance, rather than benefiting more proficient students. Nevertheless, Sharme and Severn (2008) argue that one of the major reasons formative feedback assists learning development is because it avoids high anxiety levels of students created by more formal summative feedback or examinations. In summary, it is likely that debriefing techniques improve professional practice at all levels and in many contexts, developing clinical skills and competence (Thomas and Panchagnula, 2008). The evidence to date is, however, not substantial.

Formative debriefing and feedback processes enhance experiential learning and are an essential component of simulation training (Thomas and Taylor, 2012). However, to improve learning, facilitation skills are indispensable in accordance with best practice. Debriefing techniques are incorporated into a broad spectrum of curricula, including individual and team training for clinical and critical events. The process is essential following critical events in clinical practice, but should also be incorporated into programs of learning following formative and summative assessments. Benefits will be realized in clinical skills and simulation-based learning and teaching while debriefing and feedback techniques are also likely to benefit individuals and teams in approaches such as case‑based and problem‑based learning. However, Welters, Gibson, Mogk and Wenstone (2011), argue that the clinical impact on patient care of debriefing as learning for nurses has not been measured to date. To this end, further research is warranted fully to establish educational applications and the short‑term and long‑term effect of the educational approach.

 

References

Antai-Otong, D., 2001. Critical Incident Stress Debriefing: A Health Promotion Model for Workplace Violence. Perspectives in Psychiatric Care, 37(4), pp.125-132.

Bonnel, W. and Smith, K., 2010. Teaching technologies in nursing and the health professions. New York: Springer Pub.

Couper, K. and Perkins, G., 2013. Debriefing after resuscitation. Current Opinion in Critical Care, 19(3), pp.188-194.

Currey, J. and Leslie, G., 2010. Social networking and professional debriefing—Personal risk management. Australian Critical Care, 23(3), pp.103-104.

Dausey, D., 2005. Tests to evaluate public health disease reporting systems in local public health agencies. Santa Monica, CA: RAND Center for Domestic and International Health Security.

Doherty, P. and Digby, B., 2007. Analysis of critical incidents during the interhospital transport of critically ill patients. Critical Care, 11(Suppl 2), p.P502.

Donnelly, M. and Rowling, L., 2007. The impact of critical incidents on school counsellors.Bereavement Care, 26(1), pp.11-14.

Dorman, T., 2008. Debriefing in the intensive care unit: A feedback tool to facilitate bedside teaching.Yearbook of Critical Care Medicine, 2008, pp.330-331.

Furtado, T., Gergovich, K. and Wild, D., 2010. PMC30 COGNITIVE DEBRIEFING METHODS IN TRANSLATION OF PROS:A MULTI-NATIONAL. Value in Health, 13(7), p.A334.

Ghaye, T. and Lillyman, S., 2006. Learning journals and critical incidents. London: Quay Books.

Grice, T. and Greenan, J., 2008. Nursing. Oxford: Oxford University Press.

Halpern, J. and Tramontin, M., 2007. Disaster mental health. Belmont, CA.: Thomson Brooke/Cole.

Haugen, D., 2008. Health care. Detroit: Greenhaven Press/Gale.

Hunnicutt, S., 2010. Universal health care. Detroit: Greenhaven Press.

Jacobs, B. and Coppes, M., 2012. Safety and reliability in pediatrics. Philadelphia, Pa.: Saunders.

Kiekkas, P., Aretha, D., Stefanopoulos, N. and Baltopoulos, G., 2012. Knowledge is power: studying critical incidents in intensive care. Critical Care, 16(1), p.102.

Levine, A., 2013. The comprehensive textbook of healthcare simulation. New York, NY: Springer.

Merino, N., 2011. Health care. Detroit, MI: Greenhaven Press.

Minden, C. and Armantrout, L., 2006. Nurses. Chanhassen, MN: Child’s World.

Murray, J., 2011. Nurses. Edina, Minn.: ABDO Publishing Co.

Needham, H. and Sands, N., 2010. Post-Seclusion Debriefing: A Core Nursing Intervention.Perspectives in Psychiatric Care, 46(3), pp.221-233.

Reeves, K., 2004. Nurses nurturing nurses. Nurse Leader, 2(6), pp.47-53.

Schenarts, P. and Tyson, G., 2008. Combining audiovisual feedback and debriefing: Learning or just imitating?*. Critical Care Medicine, 36(10), pp.2948-2949.

Schenarts, P., 2007. Debriefing is an effective method for providing feedback and ensuring adherence to best clinical practice by residents in the intensive care unit*. Critical Care Medicine, 35(3), pp.957-958.

Sharma, V. and Severn, A., 2008. Cardiovascular system: critical incidents. Anaesthesia & Intensive Care Medicine, 9(11), pp.483-486.

Stavans, I., 2010. Health care. Santa Barbara, Calif.: Greenwood.

Thomas, A. and Panchagnula, U., 2008. Medication-related patient safety incidents in critical care: a review of reports to the UK National Patient Safety Agency*. Anaesthesia, 63(7), pp.726-733.

Thomas, A. and Taylor, R., 2012. Review of patient safety incidents reported from critical care units in North-West England in 2009 and 2010. Anaesthesia, 67(7), pp.706-713.

Trzeciak, S., 2009. Improving In-Hospital Cardiac Arrest Process and Outcomes With Performance Debriefing. Yearbook of Critical Care Medicine, 2009, pp.75-76.

Walker, G., 1990. Crisis-care in critical incident debriefing. Death Studies, 14(2), pp.121-133.

Welters, I., Gibson, J., Mogk, M. and Wenstone, R., 2011. Major sources of critical incidents in intensive care. Critical Care, 15(5), p.R232.

Zeiger, J., 2011. Nurses. Ann Arbor, Mich.: Cherry Lake Pub.

 

 

 

 

 

 

 

 

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