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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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Diaz-Navarro C, Jones B, Pugh G, Moneypenny M, Lazarovici M, Grant DJ. Improving quality through simulation; developing guidance to design simulation interventions following key events in healthcare. Adv Simul (Lond) 2024; 9:30. [PMID: 39014494 PMCID: PMC11253482 DOI: 10.1186/s41077-024-00300-8] [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: 09/27/2023] [Accepted: 06/18/2024] [Indexed: 07/18/2024] Open
Abstract
Simulation educators are often requested to provide multidisciplinary and/or interprofessional simulation training in response to critical incidents. Current perspectives on patient safety focus on learning from failure, success and everyday variation. An international collaboration has led to the development of an accessible and practical framework to guide the implementation of appropriate simulation-based responses to clinical events, integrating quality improvement, simulation and patient safety methodologies to design appropriate and impactful responses. In this article, we describe a novel five-step approach to planning simulation-based interventions after any events that might prompt simulation-based learning in healthcare environments. This approach guides teams to identify pertinent events in healthcare, involve relevant stakeholders, agree on appropriate change interventions, elicit how simulation can contribute to them and share the learning without aggravating the second victim phenomenon. The framework is underpinned by Deming's System of Profound Knowledge, the Model for Improvement and translational simulation. It aligns with contemporary socio-technical models in healthcare, by emphasising the role of clinical teams in designing adaptation and change for improvement, as well as encouraging collaborations to enhance patient safety in healthcare. For teams to achieve this adaptive capacity that realises organisational goals of continuous learning and improvement requires the breaking down of historical silos through the creation of an infrastructure that formalises relationships between service delivery, safety management, quality improvement and education. This creates opportunities to learn by design, rather than chance, whilst striving to close gaps between work as imagined and work as done.
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Affiliation(s)
- Cristina Diaz-Navarro
- Health Education and Improvement Wales, Cardiff, UK.
- Cardiff and Vale University Health Board, Cardiff, UK.
| | - Bridie Jones
- Health Education and Improvement Wales, Cardiff, UK
| | - Gethin Pugh
- Health Education and Improvement Wales, Cardiff, UK
- Improvement Cymru Academy, Cardiff, UK
| | - Michael Moneypenny
- Clinical Skills Managed Educational Network, NHS Education for Scotland, Dundee, UK
- Association for Simulated Practice in Healthcare, Lichfield, UK
| | - Marc Lazarovici
- Institut Für Notfallmedizin Und Medizinmanagement (INM), LMU University Hospital, Munich, Germany
- SESAM - Society for Simulation in Europe, Munich, Germany
| | - David J Grant
- SESAM - Society for Simulation in Europe, Munich, Germany
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Faculty of Health Sciences, University of Bristol Medical School, Bristol, UK
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Garcia SI, Finch AS, Ridgeway JL, Beckman TJ, Montori VM, Rivera M, Gajic O, Kennedy CC, Kelm DJ. Understanding Team Dynamics and Culture of Safety Using Video Reflexive Ethnography during Real-Time Emergent Intubation. Ann Am Thorac Soc 2024; 21:1065-1073. [PMID: 38470228 DOI: 10.1513/annalsats.202310-901oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/08/2024] [Indexed: 03/13/2024] Open
Abstract
Rationale: Endotracheal intubation is the third most common bedside procedure in U.S. hospitals. In over 40% of intubations, preventable complications attributable to human factors occur. A better understanding of team dynamics during intubation may improve patient safety. Objectives: To explore team dynamics and safety-related actions during emergent endotracheal intubations in the emergency department and intensive care unit and to engage members of the care team in reflection for process improvement through a novel video-based team debriefing technique. Methods: Video-reflexive ethnography involves in situ video recording and reflexive discussions with practitioners to scrutinize behaviors and to identify opportunities for improvement. In this study, real-time intubations were recorded in the emergency department and intensive care unit at Mayo Clinic Rochester, and facilitated video-reflexive sessions were conducted with the multidisciplinary procedural teams. Themes about team dynamics and safety-related action were identified inductively from transcriptions of recorded sessions. Results: Between December 2022 and January 2023, eight video-reflexive sessions were conducted with a total of 78 participants. Multidisciplinary members included nurses (n = 23), respiratory therapists (n = 16), pharmacists (n = 7), advanced practitioners (n = 5), and physicians (n = 26). In video-reflexive discussions, major safety gaps were identified and several solutions were proposed related to the use of a multidisciplinary intubation checklist, standardized communication and team positioning, developing a culture of safety, and routinely debriefing after the procedure. Conclusions: The findings of this study may inform the development of a team supervision model for emergent endotracheal intubations. This approach could integrate key components such as a multidisciplinary intubation checklist, standardized communication and team positioning, a culture of safety, and debriefing as part of the procedure itself.
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Affiliation(s)
| | | | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Ognjen Gajic
- Division of Pulmonary, Critical Care, and Sleep Medicine
| | - Cassie C Kennedy
- Division of Pulmonary, Critical Care, and Sleep Medicine
- Division of Healthcare Delivery Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; and
| | - Diana J Kelm
- Division of Pulmonary, Critical Care, and Sleep Medicine
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Shepherd WB, Patterson K, Blake J, Ward D, Clarke A, Diaz-Navarro C, Abdulsatar F. Impact of a debrief tool in acute child and adolescent mental health inpatient units: a centre's experience. BMJ Open Qual 2024; 13:e002704. [PMID: 38782486 PMCID: PMC11116849 DOI: 10.1136/bmjoq-2023-002704] [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] [Received: 12/01/2023] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
This manuscript presents the pioneering use of a post-event staff debriefing tool, TALK, in Acute Child and Adolescent Mental Health Units (CAMHU). While unsuccessful in reducing the rate and severity of patient behavioural events, our centre observed promising psychological benefits for CAMHU staff as a result of debriefing, with the tool promoting emotional resiliency and providing a platform for open conversations. Debriefing also served as a venue for patient concerns with care to be raised by staff, addressed and reflected in updated care plans. This initiative demonstrates the utility of debriefing to foster a culture of learning, improve staff wellness and enhance patient safety in CAMHU settings.
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Affiliation(s)
- William Billal Shepherd
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | | | - Jessica Blake
- Department of Child and Adolescent Psychiatry, London Health Sciences Centre, London, Ontario, Canada
| | - Danielle Ward
- London Health Sciences Centre, London, Ontario, Canada
| | - Ashlee Clarke
- Department of Child and Adolescent Psychiatry, London Health Sciences Centre, London, Ontario, Canada
| | | | - Farah Abdulsatar
- Department of Paediatrics, Western University, London, Ontario, Canada
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Phillips EC, Smith SE, Tallentire V, Blair S. Systematic review of clinical debriefing tools: attributes and evidence for use. BMJ Qual Saf 2024; 33:187-198. [PMID: 36977575 DOI: 10.1136/bmjqs-2022-015464] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND AND OBJECTIVES Clinical debriefing (CD) following a clinical event has been found to confer benefits for staff and has potential to improve patient outcomes. Use of a structured tool to facilitate CD may provide a more standardised approach and help overcome barriers to CD; however, we presently know little about the tools available. This systematic review aimed to identify tools for CD in order to explore their attributes and evidence for use. METHODS A systematic review was conducted in line with PRISMA standards. Five databases were searched. Data were extracted using an electronic form and analysed using critical qualitative synthesis. This was guided by two frameworks: the '5 Es' (defining attributes of CD: educated/experienced facilitator, environment, education, evaluation and emotions) and the modified Kirkpatrick's levels. Tool utility was determined by a scoring system based on these frameworks. RESULTS Twenty-one studies were included in the systematic review. All the tools were designed for use in an acute care setting. Criteria for debriefing were related to major or adverse clinical events or on staff request. Most tools contained guidance on facilitator role, physical environment and made suggestions relating to psychological safety. All tools addressed points for education and evaluation, although few described a process for implementing change. Staff emotions were variably addressed. Many tools reported evidence for use; however, this was generally low-level, with only one tool demonstrating improved patient outcomes. CONCLUSION Recommendations for practice based on the findings are made. Future research should aim to further examine outcomes evidence of these tools in order to optimise the potential of CD tools for individuals, teams, healthcare systems and patients.
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Affiliation(s)
- Emma Claire Phillips
- Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, UK
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Samantha Eve Smith
- Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, UK
| | - Victoria Tallentire
- Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, UK
| | - Sheena Blair
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, 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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Debriefing Gold: Harnessing the Power of Debriefing Data to Inform Education. West J Emerg Med 2023; 24:94-97. [PMID: 36735011 PMCID: PMC9897256 DOI: 10.5811/westjem.2022.12.57727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/21/2022] [Indexed: 01/28/2023] Open
Abstract
Debriefing is a critical element in healthcare, both in the clinical environment and in the simulation lab. Often, what is said at a debriefing is not recorded, leading to loss of critical data that could be used to inform future simulations, education, and systems improvement. In this perspective piece, we explain the powerful role that capturing debriefing data can have for identifying themes to improve learners' knowledge and skills, as well as inform data-driven systems change and initiatives.
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Evans TR, Burns C, Essex R, Finnerty G, Hatton E, Clements AJ, Breau G, Quinn F, Elliott H, Smith LD, Matthews B, Jennings K, Crossman J, Williams G, Miller D, Harold B, Gurnett P, Jagodzinski L, Smith J, Milligan W, Markowski M, Collins P, Yoshimatsu Y, Margalef Turull J, Colpus M, Dayson ML, Weldon S. A systematic scoping review on the evidence behind debriefing practices for the wellbeing/emotional outcomes of healthcare workers. Front Psychiatry 2023; 14:1078797. [PMID: 37032950 PMCID: PMC10080145 DOI: 10.3389/fpsyt.2023.1078797] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/13/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Debriefings give healthcare workers voice through the opportunity to discuss unanticipated or difficult events and recommend changes. The typical goal of routine debriefings has been to improve clinical outcomes by learning through discussion and reflection of events and then transferring that learning into clinical practice. However, little research has investigated the effects of debriefings on the emotional experiences and well-being of healthcare workers. There is some evidence that debriefings are a multi-faceted and cost-effective intervention for minimising negative health outcomes, but their use is inconsistent and they are infrequently adopted with the specific intention of giving healthcare workers a voice. The purpose of this systematic scoping review is therefore to assess the scope of existing evidence on debriefing practices for the well-being and emotional outcomes of healthcare workers. Methods Following screening, 184 papers were synthesised through keyword mapping and exploratory trend identification. Results The body of evidence reviewed were clustered geographically, but diverse on many other criteria of interest including the types of evidence produced, debriefing models and practices, and outcomes captured. Discussion The current review provides a clear map of our existing understanding and highlights the need for more systematic, collaborative and rigorous bodies of evidence to determine the potential of debriefing to support the emotional outcomes of those working within healthcare. Systematic Review Registration https://osf.io/za6rj.
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Affiliation(s)
- Thomas Rhys Evans
- School of Human Sciences, University of Greenwich, London, United Kingdom
- Institute for Lifecourse Development, University of Greenwich, London, United Kingdom
- *Correspondence: Thomas Rhys Evans,
| | - Calvin Burns
- School of Human Sciences, University of Greenwich, London, United Kingdom
- Institute for Lifecourse Development, University of Greenwich, London, United Kingdom
| | - Ryan Essex
- Institute for Lifecourse Development, University of Greenwich, London, United Kingdom
| | - Gina Finnerty
- Institute for Lifecourse Development, University of Greenwich, London, United Kingdom
- School of Health Sciences, University of Greenwich, London, United Kingdom
| | - Ella Hatton
- School of Psychology, Arden University, Coventry, United Kingdom
| | | | - Genevieve Breau
- School of Human Sciences, University of Greenwich, London, United Kingdom
| | - Francis Quinn
- School of Applied Social Studies, Robert Gordon University, Aberdeen, United Kingdom
| | - Helen Elliott
- School of Health Sciences, University of Greenwich, London, United Kingdom
| | - Lorraine D. Smith
- School of Education, University of Greenwich, London, United Kingdom
| | - Barry Matthews
- School of Health Sciences, University of Greenwich, London, United Kingdom
| | - Kath Jennings
- School of Health Sciences, University of Greenwich, London, United Kingdom
| | - Jodie Crossman
- School of Sport and Health Sciences, University of Brighton, Brighton, United Kingdom
| | - Gareth Williams
- School of Health Sciences, University of Greenwich, London, United Kingdom
| | - Denise Miller
- School of Education, University of Greenwich, London, United Kingdom
| | - Benjamin Harold
- School of Health Sciences, University of Greenwich, London, United Kingdom
| | - Philip Gurnett
- School of Health Sciences, University of Greenwich, London, United Kingdom
- Greenwich Learning and Simulation Centre, University of Greenwich, London, United Kingdom
| | - Lee Jagodzinski
- School of Health Sciences, University of Greenwich, London, United Kingdom
- Greenwich Learning and Simulation Centre, University of Greenwich, London, United Kingdom
| | - Julie Smith
- School of Health Sciences, University of Greenwich, London, United Kingdom
| | - Wendy Milligan
- School of Health Sciences, University of Greenwich, London, United Kingdom
| | - Marianne Markowski
- Institute for Lifecourse Development, University of Greenwich, London, United Kingdom
- School of Health Sciences, University of Greenwich, London, United Kingdom
| | - Peter Collins
- School of Human Sciences, University of Greenwich, London, United Kingdom
- Institute for Lifecourse Development, University of Greenwich, London, United Kingdom
| | - Yuki Yoshimatsu
- School of Human Sciences, University of Greenwich, London, United Kingdom
- Lewisham and Greenwich NHS Trust, London, United Kingdom
| | | | - Mark Colpus
- School of Human Sciences, University of Greenwich, London, United Kingdom
| | - Mark L. Dayson
- Institute for Lifecourse Development, University of Greenwich, London, United Kingdom
- School of Health Sciences, University of Greenwich, London, United Kingdom
| | - Sharon Weldon
- Institute for Lifecourse Development, University of Greenwich, London, United Kingdom
- School of Health Sciences, University of Greenwich, London, United Kingdom
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Adnan NBB, Dafny HA, Baldwin C, Jakimowitz S, Chalmers D, Aroury AMA, Chamberlain D. What are the solutions for well-being and burn-out for healthcare professionals? An umbrella realist review of learnings of individual-focused interventions for critical care. BMJ Open 2022; 12:e060973. [PMID: 36691206 PMCID: PMC9462087 DOI: 10.1136/bmjopen-2022-060973] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 08/18/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To determine what, how, for whom and under what conditions individual-focused interventions are effective to improve well-being and decrease burn-out among critical care healthcare professionals. DESIGN This study is an umbrella review that used the realist approach, using Realist and Meta-narrative Evidence Synthesis: Evolving Standards guidelines. PsycINFO, Web of Science, CINAHL, MEDLINE, Scopus, ClinicalTrials.gov and ISRCTN databases were searched for published and unpublished systematic reviews and meta-analyses literature between 2016 and 2020. The team appraised and extracted data and identified relationships between content, mechanism and outcomes (CMOs). Theory prepositions were developed using CMOs and were used to refine the existing programme. RESULTS A total of 81 interventions from 17 reviews were mapped, including mindfulness interventions, cognitive-behavioural therapy, self-care and coping strategies. The revised programme theory determined that contextual factors such as ethnicity, workload, and work schedules play a crucial role in determining the effectiveness of interventions. Mechanisms including the interventions' interests, acceptance, and receptivity are also influential in determining engagement and adherence to the intervention. Findings suggest that the solution for burn-out is complex. However, it offers an optimistic view of tailoring and customising one or a combination of interventions, integrating structured education and components of emotional intelligence. Self-care, social support, awareness or mindfulness and self-efficacy are prime components to improve emotional intelligence and resilience for critical care healthcare professionals to improve well-being and decrease burn-out experience. CONCLUSIONS These findings provide realistic and reliable reporting of outcomes to better support implementation within the 'real world'. Future research such as seeking validation using expert opinions can provide further in depth understanding of hidden contextual factors, mechanisms and their interactions to provide a greater depth of knowledge ready for application with the critical care population.
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Affiliation(s)
- Nurul Bahirah Binte Adnan
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
| | - Hila Ariela Dafny
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
| | - Claire Baldwin
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
| | - Samantha Jakimowitz
- School of Nursing and Midwifery, University of Technology Sydney, Sydney, New South Wales, Australia
| | | | - Ammar Moh'd Ahmad Aroury
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
| | - Diane Chamberlain
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
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Clinical Debriefing in Cardiology Teams: A National Survey in Spain. J Nurs Care Qual 2022; 37:E67-E72. [PMID: 35984691 DOI: 10.1097/ncq.0000000000000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Clinical debriefing (CD) improves patient safety and builds team resilience. PURPOSE We describe the current use of CD by multiprofessional Spanish cardiology team members. METHODS A self-administered survey exploring 31 items was disseminated online in October 2020. A comparison was made between respondents that who experience in CD with inexperienced respondents. Inferential analysis was done using Pearson's χ2 test. RESULTS Out of 167 valid responses, 45.5% had been completed by cardiology nurses. One-third of the respondents had experience in CD. Most common situations preceding CD were those with negative outcomes (81.8%). Time constraint was the most commonly reported barrier (76.3%); however, it was significantly less than the expectation of inexperienced respondents (92%, P < .01). Overall, only 28.2% reported self-confidence in their skills to lead a CD. CONCLUSIONS There is a necessity in Spanish cardiology teams to receive training in CD and embed it in their daily practice.
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Paquay M, Dubois N, Diep AN, Graas G, Sassel T, Piazza J, Servotte JC, Ghuysen A. “Debriefing and Organizational Lessons Learned” (DOLL): A Qualitative Study to Develop a Classification Framework for Reporting Clinical Debriefing Results. Front Med (Lausanne) 2022; 9:882326. [PMID: 35814768 PMCID: PMC9263566 DOI: 10.3389/fmed.2022.882326] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe COVID-19 crisis has radically affected our healthcare institutions. Debriefings in clinical settings provide a time for the clinicians to reflect on the successes (pluses) and difficulties (deltas) encountered. Debriefings tend to be well-received if included in the broader management of the unit. The goal of this study was to develop a framework to categorize these debriefings and to assess its worthiness.MethodsA qualitative approach based on a grounded theory research method was adopted resulting in the “Debriefing and Organizational Lessons Learned” (DOLL) framework. Debriefings were conducted within two Emergency Departments of a Belgian University Hospital during an 8-week period. In the first step, three researchers used debriefing transcripts to inductively develop a tentative framework. During the second step, these three researchers conducted independent categorizations of the debriefings using the developed framework. In step 3, the team analyzed the data to understand the utility of the framework. Chi-square was conducted to examine the associations between the item types (pluses and deltas) and the framework's dimensions.ResultsThe DOLL is composed of seven dimensions and 13 subdimensions. Applied to 163 debriefings, the model identified 339 items, including 97 pluses and 242 deltas. Results revealed that there was an association between the frequency of pluses and deltas and the dimensions (p < 0.001). The deltas were mainly related to the work environment (equipment and maintenance) (p < 0.001) while the pluses identified tended to be related to the organization of the unit (communication and roles) (p < 0.001). With leadership's support and subsequent actions, clinicians were more enthusiastic about participating and the researchers anecdotally detected a switch toward a more positive organizational learning approach.ConclusionThe framework increases the potential value of clinical debriefings because it organizes results into actionable areas. Indeed, leadership found the DOLL to be a useful management tool. Further research is needed to investigate how DOLL may work in non-crisis circumstances and further apply the DOLL into incident reporting and risk management process of the unit.
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Affiliation(s)
- Méryl Paquay
- Department of Emergency, Quartier Hôpital, University Hospital of Liege, Liège, Belgium
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
- *Correspondence: Méryl Paquay
| | - Nadège Dubois
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
| | - Anh Nguyet Diep
- Biostatistics Unit, Quartier Hôpital, University of Liège, Liège, Belgium
| | - Gwennaëlle Graas
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
| | - Tamara Sassel
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
| | - Justine Piazza
- Department of Emergency, Quartier Hôpital, University Hospital of Liege, Liège, Belgium
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
| | | | - Alexandre Ghuysen
- Department of Emergency, Quartier Hôpital, University Hospital of Liege, Liège, Belgium
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
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Morgan S, Jones B. Developing pre-registration nurses' resilience to mass casualty situations through the pedagogy of simulation. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:136-141. [PMID: 35152742 DOI: 10.12968/bjon.2022.31.3.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Simulation has become a core component of nursing curricular worldwide. Within a three-year, pre-registration degree typically students would not be exposed to disaster type situations and it was believed that a well-coordinated simulation exercise could replicate this. It was hoped that the simulation would require students to think quickly on their feet and transfer acquired skills. Worldwide disasters including the current novel coronavirus have, heightened the need for well-prepared resilient health professionals capable of responding to many different types of emergencies including mass casualty situations. The simulated event involved 80 adult field student nurses, 19 probationer police officers, 6 photojournalism students, 2 Welsh Ambulance paramedics, 5 staff from 203 Field Hospital, 2 St John Cymru Wales Officers, 1 community first responder and 6 Fire and Rescue personnel. All these individuals came together to undertake a simulated emergency response to a mass casualty incident. Behaviours and clinical skills were observed throughout the event along with interprofessional interactions.
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Affiliation(s)
- Sara Morgan
- Senior Lecturer Advanced Practice, University of South Wales, Pontypriddd
| | - Bridie Jones
- Academic Subject Manager, Head of Professional Practice and Development, University of South Wales, Pontypriddd
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Stafford JL, Leon-Castelao E, Klein Ikkink AJ, Qvindesland SA, Garcia-Font M, Szyld D, Diaz-Navarro C. Clinical debriefing during the COVID-19 pandemic: hurdles and opportunities for healthcare teams. Adv Simul (Lond) 2021; 6:32. [PMID: 34526150 PMCID: PMC8441031 DOI: 10.1186/s41077-021-00182-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/24/2021] [Indexed: 01/26/2023] Open
Abstract
The COVID-19 pandemic and the subsequent pressures on healthcare staff and resources have exacerbated the need for clinical teams to reflect and learn from workplace experiences. Surges in critically ill patients, the impact of the disease on the workforce and long term adjustments in work and life have upturned our normality. Whilst this situation has generated a new 'connectedness' within healthcare workers, it also continues to test our resilience.An international multi-professional collaboration has guided the identification of ongoing difficulties to effective communication and debriefing, as well as emerging opportunities to promote a culture of dialogue. This article outlines pandemic related barriers and new possibilities categorising them according to task management, teamwork, situational awareness and decision making. It describes their direct and indirect impact on clinical debriefing and signposts towards solutions to overcome challenges and, building on new bridges, advance team conversations that allow us to learn, improve and support each other.This pandemic has brought clinical professionals together; nevertheless, it is essential to invest in further developing and supporting cohesive teams. Debriefing enables healthcare teams and educators to mitigate stress, build resilience and promote a culture of continuous learning and patient care improvement.
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Affiliation(s)
- Jody L Stafford
- Department of Perfusion/Cardiothoracic Surgery, Cardiff and Vale University Health Board, Cardiff, UK
| | - Esther Leon-Castelao
- Clinical Simulation Laboratory, Faculty of Medicine and Healthcare Sciences, University of Barcelona, Barcelona, Spain
| | - Albert J Klein Ikkink
- Wenckebach Simulation Center for Training, Education and Research, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Munt Garcia-Font
- Clinical Simulation Laboratory, Faculty of Medicine and Healthcare Sciences, University of Barcelona, Barcelona, Spain
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Kolbe M, Schmutz S, Seelandt JC, Eppich WJ, Schmutz JB. Team debriefings in healthcare: aligning intention and impact. BMJ 2021; 374:n2042. [PMID: 34518169 DOI: 10.1136/bmj.n2042] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Michaela Kolbe
- University Hospital Zurich, Simulation Centre, Switzerland
- ETH Zurich, Switzerland
| | - Sven Schmutz
- University Hospital Bern, Inselspital, Switzerland
| | | | - Walter J Eppich
- RCSI University of Medicine and Health Sciences, RCSI SIM Centre for Simulation Education and Research, Ireland
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Brazil V, Williams J. How to lead a hot debrief in the emergency department. Emerg Med Australas 2021; 33:925-927. [PMID: 34467666 DOI: 10.1111/1742-6723.13856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Victoria Brazil
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,Emergency Department, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Jennifer Williams
- Emergency Department, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia.,Griffith University School of Medicine, Gold Coast, Queensland, Australia
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