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Howard R. Implementing debriefing after cardiac arrest: benefits and challenges. Nurs Stand 2024; 39:34-38. [PMID: 38946428 DOI: 10.7748/ns.2024.e12273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 07/02/2024]
Abstract
Healthcare professionals, including nurses, will be involved in the care and management of patients in cardiac arrest. This highly stressful and demanding situation can lead to breakdowns in communication, difficulty in decision-making and emotional distress for members of the healthcare team. Debriefing is a recommended tool that team members can use to acknowledge what went well, what could be improved and areas for learning or development. However, debriefing is often not prioritised due to pressures in clinical practice. This article discusses the benefits of debriefing and outlines some of the approaches and tools that may be used. The author argues that by recognising the importance of debriefing after cardiac arrests in the hospital setting and committing to best practices, nurses can be better prepared for the challenges of resuscitation and improve patient outcomes.
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Affiliation(s)
- Rachel Howard
- Liverpool John Moores University, Liverpool, England
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2
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Zaghini F, Fiorini J, Moons P, Sili A. Cardiovascular nurses and organizational well-being: a systematic review. Eur J Cardiovasc Nurs 2024; 23:213-220. [PMID: 37561990 DOI: 10.1093/eurjcn/zvad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 08/12/2023]
Abstract
AIMS This systematic review assesses the organizational well-being of nurses working in cardiovascular settings and identifies environmental variables influencing it. METHODS AND RESULTS The Joanna Briggs Institute's methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines have been followed. The search was conducted, from the database inception up to and including 1 December 2022, on Medline (via PubMed), Cumulative Index of Nursing and Allied Health, Cochrane Library, and Scopus. Critical appraisal and data extraction were conducted using standardized tools. Six articles of high quality were included. These mostly concerned cross-sectional studies, conducted in heterogeneous contexts, which highlight the peculiarity of the cardiovascular nursing setting. Three thematic areas were identified: stressors of cardiovascular settings; outcomes of stressors on nurses; and coping strategies used by cardiovascular nurses to deal with such stress factors. Identified stress factors included a lack of autonomy, conflicts between professional and family roles, high workloads, and stressful relationships with patients and caregivers. These organizational variables could generate nurses' burnout, depression, irritability, and/or sleep disorders. In trying to cope with such stressors, cardiovascular nurses used different strategies for compensating, avoiding, escaping, or ignoring the problem, or, in other cases, became somewhat aggressive. CONCLUSION Considering the limited data, cardiovascular nursing coping strategies should be further investigated, so that effective pathways for preventing or limiting stress factors can be identified and applied by the organizations. Monitoring and intervening on stress factors in this care setting could improve cardiovascular nurses' organizational well-being and accordingly patients' outcomes. REGISTRATION PROSPERO: CRD42022355669.
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Affiliation(s)
- Francesco Zaghini
- Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier, 1, 00133 Rome, Italy
| | - Jacopo Fiorini
- Department of Nursing Professions, University Hospital of Tor Vergata, Viale Oxford, 81, 00133 Rome, Italy
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35 PB 7001, 3000 Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Arvid Wallgrens backe 1, 413 46 Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, Klipfontein Rd, Rondebosch, 7700 Cape Town, South Africa
| | - Alessandro Sili
- Department of Nursing Professions, University Hospital of Tor Vergata, Viale Oxford, 81, 00133 Rome, Italy
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Billings J, Zhan Yuen Wong N, Nicholls H, Burton P, Zosmer M, Albert I, Grey N, El-Leithy S, Murphy D, Tehrani N, Wheatley J, Bloomfield MAP, Greene T. Post-incident psychosocial interventions after a traumatic incident in the workplace: a systematic review of current research evidence and clinical guidance. Eur J Psychotraumatol 2023; 14:2281751. [PMID: 38032045 PMCID: PMC10990448 DOI: 10.1080/20008066.2023.2281751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
Background: After a traumatic incident in the workplace organisations want to provide support for their employees to prevent PTSD. However, what is safe and effective to offer has not yet been established, despite many organisations offering some form of intervention after a traumatic event.Objective: To systematically review the evidence for post-incident psychosocial interventions offered within one month of a workplace trauma, and to compare the content, effectiveness and acceptability of these interventions. Given the lack of a yet clearly established evidence-base in this field, we sought to examine both published empirical research as well as guidelines published by expert groups working with staff in high-risk roles.Methods: We conducted systematic searches for empirical research across bibliographic databases and searched online for clinical practice guidelines to April 2023. We were also referred to potentially relevant literature by experts in workplace trauma. Both empirical research and clinical guidelines were appraised for their quality.Results: A total of 80 research studies and 11 clinical practice guidelines were included in the review. Interventions included Critical Incident Stress Debriefing (CISD), Critical Incident Stress Management (CISM), unspecified Debriefing, Trauma Risk Management (TRiM), Psychological First Aid (PFA), EMDR, CBT and group counselling. Most research and guidance were of poor quality. The findings of this review do not demonstrate any harm caused by CISD, CISM, PFA, TRiM, EMDR, group counselling or CBT interventions when delivered in a workplace setting. However, they do not conclusively demonstrate benefits of these interventions nor do they establish superiority of any specific intervention. Generic debriefing was associated with some negative outcomes. Current clinical guidelines were inconsistent with the current research evidence base. Nevertheless, interventions were generally valued by workers.Conclusions: Better quality research and guidance is urgently needed, including more detailed exploration of the specific aspects of delivery of post-incident interventions.
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Affiliation(s)
- Jo Billings
- Division of Psychiatry, University College London, London, UK
| | | | - Helen Nicholls
- Division of Psychiatry, University College London, London, UK
| | - Peter Burton
- Division of Psychiatry, University College London, London, UK
| | - Maya Zosmer
- Division of Psychiatry, University College London, London, UK
| | - Idit Albert
- King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Nick Grey
- University of Sussex, Falmer, UK
- Sussex Partnership NHS Foundation Trust, Worthing, West Sussex, UK
| | | | - Dominic Murphy
- King’s College London, London, UK
- Combat Stress, London, UK
| | | | - Jon Wheatley
- Homerton Healthcare NHS Foundation Trust, London, UK
| | - Michael A. P. Bloomfield
- Division of Psychiatry, University College London, London, UK
- Camden & Islington NHS Foundation Trust, London, UK
| | - Talya Greene
- Clinical, Educational and Health Psychology, University College London, London, UK
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Paquay M, Simon R, Ancion A, Graas G, Ghuysen A. A success story of clinical debriefings: lessons learned to promote impact and sustainability. Front Public Health 2023; 11:1188594. [PMID: 37475771 PMCID: PMC10354544 DOI: 10.3389/fpubh.2023.1188594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/14/2023] [Indexed: 07/22/2023] Open
Abstract
The COVID-19 crisis impacted emergency departments (ED) unexpectedly and exposed teams to major issues within a constantly changing environment. We implemented post-shift clinical debriefings (CDs) from the beginning of the crisis to cope with adaptability needs. As the crisis diminished, clinicians voiced a desire to maintain the post-shift CD program, but it had to be reshaped to succeed over the long term. A strategic committee, which included physician and nurse leadership and engaged front-line staff, designed and oversaw the implementation of CD. The CD structure was brief and followed a debriefing with a good judgment format. The aim of our program was to discover and integrate an organizational learning strategy to promote patient safety, clinicians' wellbeing, and engagement with the post-shift CD as the centerpiece. In this article, we describe how post-shift CD process was performed, lessons learned from its integration into our ED strategy to ensure value and sustainability and suggestions for adapting this process at other institutions. This novel application of debriefing was well received by staff and resulted in discovering multiple areas for improvement ranging from staff interpersonal interactions and team building to hospital wider quality improvement initiatives such as patient throughput.
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Affiliation(s)
- Méryl Paquay
- Emergency Department, University Hospital of Liege Quartier Hôpital, Liege, Belgium
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liege, Belgium
| | | | - Aurore Ancion
- Emergency Department, University Hospital of Liege Quartier Hôpital, Liege, Belgium
| | - Gwennaëlle Graas
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liege, Belgium
| | - Alexandre Ghuysen
- Emergency Department, University Hospital of Liege Quartier Hôpital, Liege, Belgium
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liege, Belgium
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5
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Blomquist M, Lasiter S. Nurses’ coping strategies during and after an adult in‐hospital resuscitation attempt: A scoping study. J Clin Nurs 2021; 31:2437-2449. [DOI: 10.1111/jocn.16128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/20/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Michael Blomquist
- School of Nursing and Health Studies University of Missouri, Kansas City Kansas City Missouri USA
| | - Sue Lasiter
- School of Nursing and Health Studies University of Missouri, Kansas City Kansas City Missouri USA
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Galligan MM, Haggerty M, Wolfe HA, Debrocco D, Kellom K, Garcia SM, Neergaard R, Akpek E, Barg FK, Friedlaender E. From the Frontlines: A Qualitative Study of Staff Experiences With Clinical Event Debriefing. Hosp Pediatr 2021; 11:hpeds.2021-006088. [PMID: 34808664 DOI: 10.1542/hpeds.2021-006088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Clinical event debriefing (CED) can improve patient care and outcomes, but little is known about CED across inpatient settings, and participant experiences have not been well described. In this qualitative study, we sought to characterize and compare staff experiences with CED in 2 hospital units, with a goal of generating recommendations for a hospital-wide debriefing program. METHODS We conducted 32 semistructured interviews with clinical staff who attended a CED in the previous week. We explored experiences with CED, with a focus on barriers and facilitators. We used content analysis with constant comparative coding to understand priorities identified by participants. We used inductive reasoning to develop a set of CED practice recommendations to match participant priorities. RESULTS Three primary themes emerged related to CED barriers and facilitators. (1) Factors affecting attendance: most respondents voiced a need for frontline staff inclusion in CED, but they also cited competing clinical duties and scheduling conflicts as barriers. (2) Factors affecting participant engagement: respondents described factors that influence participant engagement in reflective discussion. They described that the CED leader must cultivate a psychologically safe environment in which participants feel empowered to speak up, free from judgment. (3) Factors affecting learning and systems improvement: respondents emphasized that the CED group should generate a plan for improvement with accountable stakeholders. Collectively, these priorities propose several recommendations for CED practice, including frontline staff inclusion. CONCLUSIONS In this study, we propose recommendations for CED that are derived from first-hand participant experiences. Future study will explore implementation of CED practice recommendations.
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Affiliation(s)
- Meghan M Galligan
- Departments of Pediatrics
- The Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Heather A Wolfe
- Anesthesiology and Critical Care Medicine
- The Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Katherine Kellom
- Policy Laboratory, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stephanie M Garcia
- Policy Laboratory, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rebecca Neergaard
- Family Medicine and Community Health, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eda Akpek
- Family Medicine and Community Health, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Frances K Barg
- Family Medicine and Community Health, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Jun J, Rosemberg MAS. I Am a Nurse, Not a Martyr: Qualitative Investigation of Nurses' Experiences During Onset of the Coronavirus Pandemic. Policy Polit Nurs Pract 2021; 23:48-55. [PMID: 34704859 DOI: 10.1177/15271544211054435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nurses have always played an essential role during epidemics, risking their lives caring for sick and dying patients. However, the unprecedented nature of the novel coronavirus disease 2019 (COVID-19) has left organizations and healthcare professionals ill-prepared and under-equipped to manage the severity, manifestations, and acute and long-term implications. While COVID-19 has presented profound physical and mental health implications for nurses, we know little about nurses' professional experiences within their organizational context. Thus, this qualitative descriptive study fills that gap through in-depth exploration of nurses' shared professional experiences working in hospitals during the first surge of COVID-19 in the United States. Twenty-two nurses were interviewed via telephone during April and May 2020. Through thematic analysis four main themes emerged: (1) fear, (2) collective resilience through shared trauma, (3) uncharted territory, and (4) perceived disposability. Nurses felt ill-praepared for the rapid changes wrought by COVID-19; yet they also felt proud with a renewed sense of meaning in their work. While unit colleagues were a great source of strength, nurses still reported disappointment, even feeling abandoned by their organizations. Our study indicates that nurses relied on one another to cope and find meaning. These findings are invaluable for policy development and the establishment of preventive and early intervention strategies. Done right, such efforts could better support nurses by encouraging team building, protection, and rewards to maintain nurses' wellbeing during such outbreaks and in their aftermath. Organizations also ought to make nurses' health and wellbeing a priority by streamlining communication, transparency, and leadership visibility.
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Affiliation(s)
- Jin Jun
- Center for Healthy Aging, Self-Management and Complex Care, 2647The Ohio State University, College of Nursing, Columbus, OH, USA
| | - Marie-Anne S Rosemberg
- Department of Systems, Populations and Leadership, 1259University of Michigan, School of Nursing, Ann Arbor, MI, USA
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Riley K, Middleton R, Wilson V, Molloy L. Voices from the 'resus room': An integrative review of the resuscitation experiences of nurses. J Clin Nurs 2021; 31:1164-1173. [PMID: 34542206 DOI: 10.1111/jocn.16048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/25/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nurses are often the first responders to resuscitations. Understanding their experiences of resuscitation will highlight the resuscitative context nurses work within and identify the conditions that support or hamper their delivery of safe and effective resuscitative care. AIM The aim of this integrative review is to develop an understanding of nurses' experience of resuscitation, to gain knowledge of their challenges and identify gaps in evidence. DESIGN Integrative review. METHODS The electronic databases CINAHL, MEDLINE, Scopus and Web of Science were systematically searched from 2000-2021. Methodological quality of the papers was evaluated using the Mixed Methods Appraisal Tool (MMAT). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist was used to guide and report the integrative review. RESULTS Eleven articles met criteria for review. Four themes arose from the literature that addressed nurses experiences of resuscitation: Chaos (external/internal), ethical dilemmas, clinical confidence and need for support. CONCLUSION Nurses' experiences of resuscitation are multifaceted. Addressing the challenges that nurses experience during resuscitation will help ensure that nurses' are supported in their professional growth and personal well-being. Relevance to clinical practice and research: Building nursing leadership capacity within resuscitations is an area of clinical practice/research that is gaining traction as a valid solution to address the challenges nurses experience during resuscitations. Whilst the barriers to debriefing requires a greater level of consideration within the workplace.
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Affiliation(s)
- Katherine Riley
- School of Nursing, University of Wollongong, New South Wales, Australia
| | | | - Val Wilson
- School of Nursing, University of Wollongong, New South Wales, Australia
| | - Luke Molloy
- School of Nursing, University of Wollongong, New South Wales, Australia
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9
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Olsson A, Sjöberg F, Salzmann-Erikson M. Follow the protocol and kickstart the heart-Intensive care nurses' reflections on being part of rescue situations in interdisciplinary teams. Nurs Open 2021; 8:3325-3333. [PMID: 34431610 PMCID: PMC8510712 DOI: 10.1002/nop2.1050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/20/2021] [Accepted: 07/19/2021] [Indexed: 11/09/2022] Open
Abstract
Aim To describe intensive care nurses' reflections on being part of interdisciplinary emergency teams involved in in‐hospital cardiopulmonary resuscitation. Design A qualitative descriptive design. Methods: Eighteen intensive care nurses from two regions and three hospitals in Sweden were interviewed. The data were analysed with General Inductive Analysis. Results The work for intensive care nurses in the emergency team was reflected in three phases: prevention, intervention and mitigation—referred as before, during and after the CPR situation. Conclusions The findings describe the complexity of being an intensive care nurse in an interdisciplinary emergency team, which entails managing advanced care with limited and unknown resources in a non‐familiar environment. The present findings have important clinical implications concerning the value of having debriefing sessions to reflect on and to talk about obstacles to and prerequisites for performing successful resuscitation.
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Affiliation(s)
- Annakarin Olsson
- Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Fredric Sjöberg
- Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Salzmann-Erikson
- Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
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Timothy CL, Brown AJ, Thomas EK. Implementation of a postarrest debriefing tool in a veterinary university hospital. J Vet Emerg Crit Care (San Antonio) 2021; 31:718-726. [PMID: 34432941 DOI: 10.1111/vec.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/04/2020] [Accepted: 04/25/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the use of a postarrest debriefing tool (DBT) within a university teaching hospital and to evaluate user perceptions of the tool. DESIGN Observational study over a 1-year period and associated hospital clinical personnel survey. SETTING University teaching hospital. INTERVENTIONS Qualitative data surrounding the use and utility of the DBT were analyzed, as well as survey results. MEASUREMENTS AND MAIN RESULTS Forty-four arrests occurred during the study period. Debriefing was performed after 26 of 44 (59%) cardiopulmonary resuscitation (CPR) events, of which 22 of 26 (85%) were recorded using the DBT and four without the DBT. Return of spontaneous circulation did not significantly affect the use of the DBT (p = 0.753). Most events in which debriefing was not performed occurred outside of business hours (13/18; 72%). The most frequent positive debriefing comments related to cooperation/coordination within the team (22/167; 13%). The most frequent negative debriefing comments concerned equipment issues (36/167; 22%). Of the action points generated, 57% (34/60) were directed at equipment use/availability. Teams reported that emergency drugs were appropriately administered in 21 of 22 (95%) cases. In contrast, closed loop communication was reportedly only used during 6 of 22 (27%) events. The hospital survey response rate was 56 of 338 (17%) clinical staff, of whom 37 of 56 (66%) agreed or strongly agreed that debriefing had improved team performance during CPR. Overall, 33 of 56 (60%) staff felt that the DBT had improved the debriefing process at the hospital. However, 3 of 56 (5%) staff members felt that they were unable to state their opinions in a blame-free environment during debriefing. CONCLUSIONS Implementation of a DBT enabled formal identification of strengths and training needs of resuscitation teams, and its implementation was viewed positively by the majority of hospital staff. However, further refinement of the tool and prospective studies evaluating its efficacy in improving outcome are warranted.
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Affiliation(s)
- Clare L Timothy
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - Andrew J Brown
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - Emily K Thomas
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
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Toews AJ, Martin DE, Chernomas WM. Clinical debriefing: A concept analysis. J Clin Nurs 2021; 30:1491-1501. [PMID: 33434382 DOI: 10.1111/jocn.15636] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/08/2020] [Accepted: 12/31/2020] [Indexed: 01/01/2023]
Abstract
AIMS AND OBJECTIVES The purpose of this paper is to enhance nursing and collaborative practice by presenting a concept analysis of clinical debriefing and introducing an operational definition. BACKGROUND Debriefing has taken many forms, using a variety of approaches. Variations and inconsistencies in clinical debriefing, and its related terms, still exist in the clinical setting. DESIGN Concept analysis. METHODS Walker and Avant's eight-step approach to concept analysis. RESULTS The defining attributes of clinical debriefing identified in this analysis are described as the five E's: educated/experienced facilitator, environment, education, evaluation and emotions. Antecedents identified in this analysis include the critical event, the desire or need to review such an event and the organizational awareness to execute clinical debriefs. The consequences of clinical debriefings are primarily advantageous and positively impact involved nurses, healthcare teams, patients and organizations. Empirical referents of clinical debriefing are complex and multifactorial. The productivity of a clinical debrief can be enhanced through a series of proposed questions. Together, the defining attributes, antecedents and consequences shape a proposed operational definition of clinical debriefing. CONCLUSION Clinical debriefing is a valuable tool within healthcare organizations. Debriefing can be a holistic, interprofessional, collaborative experience when all five defining attributes are present. Further investigation is required to standardise debriefing practices in clinical settings. RELEVANCE TO CLINICAL PRACTICE A concept analysis on clinical debriefing promotes uniformity of debriefing practices, reflective practice among nurses and healthcare teams, and contributes to nursing science by creating a platform for the development of practice standards, research and theory development.
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Affiliation(s)
- Andrea J Toews
- Helen Glass Center for Nursing, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - Donna E Martin
- Helen Glass Center for Nursing, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - Wanda M Chernomas
- Helen Glass Center for Nursing, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
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12
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Sugarman M, Graham B, Langston S, Nelmes P, Matthews J. Implementation of the ‘TAKE STOCK’ Hot Debrief Tool in the ED: a quality improvement project. Emerg Med J 2021; 38:579-584. [DOI: 10.1136/emermed-2019-208830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 11/04/2022]
Abstract
Hot debriefing (HoD) describes a structured team-based discussion which may be initiated following a significant event. Benefits may include improved teamwork, staff well-being and identification of learning opportunities. Existing literature indicates that while staff value HoD following significant events, it is infrequently undertaken in practice. Internationally, several frameworks for HoD have been developed, although none are widely adopted for use in the ED. A quality improvement project was conducted to introduce HoD into a single UK ED in North West England, between January and March 2019. Following stakeholder consultation, the 9-item ‘TAKE STOCK’ tool was developed. Implementation of the tool increased the number of HoD (0—2.2 HoD episodes/week). Findings from the first plan-do-study-act (PDSA) cycle are presented, which revealed the key strengths and limitations of this model. Staff perceptions of the tool were evaluated using a self-administered short questionnaire designed by the authors. Satisfaction with TAKE STOCK was assessed using 10-point numerical scales. Across respondents (n−15), average satisfaction scores exceeded 9 out of 10 concerning patient care, staff self-care, decision-making, education, teamwork and identification of equipment issues. Implementation of HoD into the ED is feasible and viewed as beneficial by staff. Implementation toolkits for TAKE STOCK have been requested by 42 additional UK hospitals and ambulance trusts, demonstrating significant interest in its use. Research is now required to formally validate HoD frameworks for use in the ED, and assess whether HoD results in sustained improvements to staff and patient outcomes.
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13
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Walker RM, Boorman RJ, Vaux A, Cooke M, Aitken LM, Marshall AP. Identifying barriers and facilitators to recognition and response to patient clinical deterioration by clinicians using a behaviour change approach: A qualitative study. J Clin Nurs 2021; 30:803-818. [PMID: 33351998 DOI: 10.1111/jocn.15620] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/03/2020] [Accepted: 12/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Failure of clinicians to recognise and respond to patient clinical deterioration is associated with increased hospital mortality. Emergency response teams are implemented throughout hospitals to support direct-care clinicians in managing patient deterioration, but patient clinical deterioration is often not identified or acted upon by clinicians in ward settings. To date, no studies have used an integrative theoretical framework in multiple sites to examine why clinicians' delay identification and action on patients' clinical deterioration. AIM To identify barriers and facilitators that influence clinicians' absent or delayed response to patient clinical deterioration using the Theoretical Domains Framework. METHODS The Theoretical Domains Framework guided: (a) semi-structured interviews with clinicians, health consumers and family members undertaken at two sites; (b) deductive analyses of inductive themes to identify barriers and facilitators to optimal care. This study complied with the COREQ research guidelines. FINDINGS Seven themes identified: (a) information transfer; (b) ownership of patient care; (c) confidence to respond; (d) knowledge and skills; (e) culture; (f) emotion; and (g) environmental context and resources. DISCUSSION The Theoretical Domains Framework identified traditional social and professional hierarchies and limitations due to environmental contexts and resources as contributors to diminished interprofessional recognition and impediments to the development of effective relationships between professional groups. Communication processes were impacted by these restraints and further confounded by inadequate policy development and limited access to regular effective team-based training. As a result, patient safety was compromised, and clinicians frustrated. CONCLUSIONS These results inform the development, implementation and evaluation of a behaviour change intervention and increase knowledge about barriers and facilitators to timely response to patient clinical deterioration. RELEVANCE TO CLINICAL PRACTICE Results contribute to understanding of why clinicians delay responding to patient clinical deterioration and suggest key recommendations to identify and challenge traditional hierarchies and practices that prevent interdisciplinary collaboration and decision-making.
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Affiliation(s)
- Rachel M Walker
- School of Nursing and Midwifery, Griffith University, Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia.,Division of Surgery, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Rhonda J Boorman
- School of Nursing and Midwifery, Griffith University, Brisbane, Qld, Australia
| | - Amanda Vaux
- Metro South Patient Flow Program, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Marie Cooke
- School of Nursing and Midwifery, Griffith University, Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia
| | - Leanne M Aitken
- School of Nursing and Midwifery, Griffith University, Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia.,School of Health Sciences, City University of London, London, UK
| | - Andrea P Marshall
- School of Nursing and Midwifery, Griffith University, Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia.,Gold Coast Health, Gold Coast, Qld, Australia
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Buhlmann M, Ewens B, Rashidi A. The impact of critical incidents on nurses and midwives: A systematic review. J Clin Nurs 2021; 30:1195-1205. [PMID: 33351975 DOI: 10.1111/jocn.15608] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/14/2020] [Accepted: 12/10/2020] [Indexed: 11/26/2022]
Abstract
AIMS To synthesise the existing literature, which focuses on the impact of critical incidents on nurses and midwives, and to explore their experiences related to the support they received in the current healthcare environment to move on from the event. DESIGN Systematic review and qualitative synthesis. DATA SOURCES The electronic databases CINAHL, MEDLINE, PsycINFO, PubMed, Embase and Nursing and Allied Health (ProQuest) were systematically searched from 2013-2018, and core authors and journals identified in the literature were manually investigated. REVIEW METHODS Qualitative studies of all research design types written in English were included according to the PRISMA reporting guidelines. The methodological quality of included studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. RESULTS A total of 7,520 potential publications were identified. After removal of duplicate citations, study selection and appraisal process, 11 qualitative primary research papers progressed to the meta-synthesis by meta-aggregation. The 179 findings and sub-findings from the included studies were extracted, combined and synthesised into three statements addressing three different aspects within the context of critical incidents: the experiences of the impact, the perceptions of support and the ability to move on. CONCLUSION This review illuminated that moving-on after critical incidents is a complex and wearisome journey for nurses and midwives. More attention should to be drawn to second victims within general nursing and midwifery practice to strengthen their ability to navigate the aftermath of critical incidents and reclaim the professional confidence indispensable to remain in the workforce.
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Affiliation(s)
- Melanie Buhlmann
- School of Nursing & Midwifery, Edith Cowan University, Bunbury, Western Australia
| | - Beverley Ewens
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia
| | - Amineh Rashidi
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia
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Conoscenti E, Martucci G, Piazza M, Tuzzolino F, Ragonese B, Burgio G, Arena G, Blot S, Luca A, Arcadipane A, Chiaramonte G. Post-crisis debriefing: A tool for improving quality in the medical emergency team system. Intensive Crit Care Nurs 2020; 63:102977. [PMID: 33358133 DOI: 10.1016/j.iccn.2020.102977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To examine clinicians' perception of quality of technical and non-technical response to emergencies and application of post crisis debriefing. DESIGN Descriptive, anonymous, self-reporting survey on the needs and perception of a post-crisis debriefing implementation. SETTING Multi-specialist medical institute in Italy focused on solid organ transplantation and organ failure support. MAIN OUTCOMES Perception of application of guidelines and evaluation of debriefing implementation during in-hospital emergencies. RESULTS Response rate to the survey was 25% (148 health care workers). Of all respondents, 86% were employed >10 years, 75% were involved in ≤5 emergencies over the previous year. Resuscitation guidelines were considered fully applied by 55%; 64% of respondents considered the teaching programme as sufficient. Of all participants, 97% were aware of the importance of teamwork dynamics, 79% were aware of the importance of the personal performance, and 52% considered emergencies as valid opportunities for professional growth. Leadership was considered important by 45% of respondents; debriefing implemented by 41%, and considered a potentially useful tool by 85%. CONCLUSION Post-crisis debriefing is a way to diffuse self-reflective and life-long learning culture; it is perceived as a powerful tool for improving quality of the rapid response system by the vast majority of those surveyed.
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Affiliation(s)
- Elena Conoscenti
- Infectious Disease and Infection Control Service, ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Gennaro Martucci
- Department of Anesthesia and Intensive Care, ISMETT, Palermo, Italy
| | - Marcello Piazza
- Department of Anesthesia and Intensive Care, ISMETT, Palermo, Italy
| | | | | | - Gaetano Burgio
- Department of Anesthesia and Intensive Care, ISMETT, Palermo, Italy
| | - Giuseppe Arena
- Department of Nursing and Healthcare Professionals, ISMETT, Palermo, Italy
| | - Stijn Blot
- Internal Medicine Department, Ghent University, Belgium
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Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, Kudenchuk PJ, Kurz MC, Lavonas EJ, Morley PT, O’Neil BJ, Peberdy MA, Rittenberger JC, Rodriguez AJ, Sawyer KN, Berg KM, Arafeh J, Benoit JL, Chase M, Fernandez A, de Paiva EF, Fischberg BL, Flores GE, Fromm P, Gazmuri R, Gibson BC, Hoadley T, Hsu CH, Issa M, Kessler A, Link MS, Magid DJ, Marrill K, Nicholson T, Ornato JP, Pacheco G, Parr M, Pawar R, Jaxton J, Perman SM, Pribble J, Robinett D, Rolston D, Sasson C, Satyapriya SV, Sharkey T, Soar J, Torman D, Von Schweinitz B, Uzendu A, Zelop CM, Magid DJ. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S366-S468. [DOI: 10.1161/cir.0000000000000916] [Citation(s) in RCA: 371] [Impact Index Per Article: 92.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Sawyer KN, Camp-Rogers TR, Kotini-Shah P, Del Rios M, Gossip MR, Moitra VK, Haywood KL, Dougherty CM, Lubitz SA, Rabinstein AA, Rittenberger JC, Callaway CW, Abella BS, Geocadin RG, Kurz MC. Sudden Cardiac Arrest Survivorship: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e654-e685. [DOI: 10.1161/cir.0000000000000747] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cardiac arrest systems of care are successfully coordinating community, emergency medical services, and hospital efforts to improve the process of care for patients who have had a cardiac arrest. As a result, the number of people surviving sudden cardiac arrest is increasing. However, physical, cognitive, and emotional effects of surviving cardiac arrest may linger for months or years. Systematic recommendations stop short of addressing partnerships needed to care for patients and caregivers after medical stabilization. This document expands the cardiac arrest resuscitation system of care to include patients, caregivers, and rehabilitative healthcare partnerships, which are central to cardiac arrest survivorship.
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Chesham B, Dawber C. The "All of Us" study - Non-clinical staff members' experience of performing cardiopulmonary resuscitation in acute care settings. Australas Emerg Care 2019; 22:243-248. [PMID: 31405626 DOI: 10.1016/j.auec.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/15/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND A multitude of Australian hospitals use non-clinical staff to assist with chest compressions and ancillary duties during cardiopulmonary resuscitation. Whilst few studies have focused on psychological implications for non-clinical staff, research into other groups indicates that a lack of attention to psychological support may adversely impact individual wellbeing, team functioning and clinical performance. The aim of this study was to explore how non-clinical workers were psychologically affected during cardiopulmonary resuscitation and factors that might mitigate adverse psychological effects. METHODS This study utilised a qualitative descriptive methodology involving semi-structured, face to face interviews to investigate the experiences of non-clinical staff involved in cardiopulmonary resuscitation. Data was collected using semi-structured interviews and a validated Post Traumatic Stress rating scale. RESULTS The study found that all 12 participants had experienced critical incident stress symptoms following their involvement in resuscitation attempts, though only one had ongoing evidence of Post Traumatic Stress Disorder. Participants felt that they needed more psychological preparation and that post-incident debriefs had been helpful but inconsistently provided and facilitated. Peer support was seen as the most significant factor in mitigating the psychological impact of critical incidents. CONCLUSION This study shows that the development and formalisation of peer support networks for non-clinical health staff warrants serious consideration. The study also indicates that non-clinical members of resuscitation teams may benefit from more psychological preparation and support with self-care.
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Affiliation(s)
- Bradley Chesham
- Emergency Department, Sunshine Coast Hospital and Health Service, 6 Doherty Street, Birtinya, QLD 4575, Australia
| | - Christopher Dawber
- Ma Mental Health Nursing, Consultation Liaison - Mental Health and Addiction Services, Sunshine Coast Hospital and Health Service, 6 Doherty Street, Birtinya, QLD 4575, Australia
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Spencer SA, Nolan JP, Osborn M, Georgiou A. The presence of psychological trauma symptoms in resuscitation providers and an exploration of debriefing practices. Resuscitation 2019; 142:175-181. [PMID: 31251894 DOI: 10.1016/j.resuscitation.2019.06.280] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/03/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Witnessing traumatic experiences can cause post-traumatic stress disorder (PTSD). The true impact on healthcare staff of attending in-hospital cardiac arrests (IHCAs) has not been studied. This cross-sectional study examined cardiac arrest debriefing practices and the burden of attending IHCAs on nursing and medical staff. METHODS A 33-item questionnaire-survey was sent to 517 doctors (of all grades), nurses and health-care assistants (HCAs) working in the emergency department, the acute medical unit and the intensive care unit of a district general hospital between April and August 2018. There were three sections: demographics; cardiac arrest and debriefing practices; trauma-screening questionnaire (TSQ). RESULTS The response rate was 414/517 (80.1%); 312/414 (75.4%) were involved with IHCAs. Out of 1463 arrests, 258 (17.6%) were debriefed. Twenty-nine of 302 (9.6%) staff screened positively for PTSD. Healthcare assistants and Foundation Year 1 doctors had higher TSQ scores than nurses or more senior doctors (p = 0.02, p = 0.02, respectively). Debriefing was not associated with PTSD risk (p = 0.98). Only 8/67 (11.9%) of resuscitation leaders had prior debriefing training. CONCLUSIONS Nearly 10% of acute care staff screened positively for PTSD as a result of attending an IHCA, with junior staff being most at risk of developing trauma symptoms. Very few debriefs occurred, possibly because of a lack of debrief training amongst cardiac arrest team leaders. More support is required for acute care nursing and medical staff following an IHCA.
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Affiliation(s)
| | - Jerry P Nolan
- Royal United Hospital, Bath, United Kingdom; Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
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