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Stileman HM, Jones CA. Revisiting the debriefing debate: does psychological debriefing reduce PTSD symptomology following work-related trauma? A meta-analysis. Front Psychol 2023; 14:1248924. [PMID: 38204890 PMCID: PMC10779682 DOI: 10.3389/fpsyg.2023.1248924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024] Open
Abstract
Psychological debriefing is an early post-trauma intervention which aims to prevent the development of PTSD and accelerate normal recovery through discussing, validating, and normalising group members responses to trauma. While originally designed in the 1980s for groups of emergency service personnel, the scope of psychological debriefing extended to individual primary victims of trauma. A Cochrane review in 2002 concluded that psychological debriefing was ineffective, yet some authors have argued that many of the studies that informed the Cochrane review did not adhere to key elements of psychological debriefing. This meta-analysis sought to re-examine the effectiveness of psychological debriefing in preventing or reducing PTSD symptoms following work-related trauma. Appropriate studies were selected from three databases (MEDLINE, Embase and PsycINFO). Inclusion criteria was intentionally broad so that features of psychological debriefing that may determine its effectiveness could be explored through a series of subgroup analyses. The overall synthesis did not find consistent evidence that psychological debriefing helps to prevent or reduce PTSD symptoms following work-related trauma. Shortcomings in the methodology and reporting of many of the studies meant that several important subgroup analyses could not be conducted. Further well-designed studies in this field are warranted to ensure that employees exposed to potentially traumatic events receive the effective support they need and deserve.
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Affiliation(s)
- Harry M. Stileman
- Centre of Applied Psychology, University of Birmingham, Birmingham, United Kingdom
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
| | - Christopher A. Jones
- Centre of Applied Psychology, University of Birmingham, Birmingham, United Kingdom
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Hancock J, Witter T, Comber S, Daley P, Thompson K, Candow S, Follett G, Somers W, Collins C, White J, Kits O. Understanding burnout and moral distress to build resilience: a qualitative study of an interprofessional intensive care unit team. Can J Anaesth 2020; 67:1541-1548. [PMID: 32844247 DOI: 10.1007/s12630-020-01789-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE The purpose of this study was to explore personal and organizational factors that contribute to burnout and moral distress in a Canadian academic intensive care unit (ICU) healthcare team. Both of these issues have a significant impact on healthcare providers, their families, and the quality of patient care. These themes will be used to design interventions to build team resilience. METHODS This is a qualitative study using focus groups to elicit a better understanding of stakeholder perspectives on burnout and moral distress in the ICU team environment. Thematic analysis of transcripts from focus groups with registered intensive care nurses (RNs), respiratory therapists (RTs), and physicians (MDs) considered causes of burnout and moral distress, its impact, coping strategies, as well as suggestions to build resilience. RESULTS Six focus groups, each with four to eight participants, were conducted. A total of 35 participants (six MDs, 21 RNs, and eight RTs) represented 43% of the MDs, 18.8% of the RNs, and 20.0% of the RTs. Themes were concordant between the professions and included: 1) organizational issues, 2) exposure to high-intensity situations, and 3) poor team experiences. Participants reported negative impacts on emotional and physical well-being, family dynamics, and patient care. Suggestions to build resilience were categorized into the three main themes: organizational issues, exposure to high intensity situations, and poor team experiences. CONCLUSIONS Intensive care unit team members described their experiences with moral distress and burnout, and suggested ways to build resilience in the workplace. Experiences and suggestions were similar between the interdisciplinary teams.
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Affiliation(s)
- Jennifer Hancock
- Department of Critical Care Medicine, Dalhousie University, Queen Elizabeth II Hospital, 1276 South Park St., Halifax, NS, B3H 2Y9, Canada.
| | - Tobias Witter
- Department of Critical Care, Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Queen Elizabeth II Hospital, Halifax, NS, Canada
| | - Scott Comber
- Rowe School of Business, Faculty of Management, Dalhousie University, Halifax, NS, Canada
| | - Patricia Daley
- MSNICU, Health Sciences Centre, Queen Elizabeth II Hospital, Halifax, NS, Canada
| | - Kim Thompson
- Respiratory Therapy Department, Central Zone, Nova Scotia Health Authority, Health Sciences Centre, Halifax, NS, Canada
| | - Stewart Candow
- Intensive Care Unit, Health Sciences Centre, Queen Elizabeth II Hospital, Halifax, NS, Canada
| | - Gisele Follett
- Respiratory Therapy DGH, Health Sciences Centre, Queen Elizabeth II Hospital, Halifax, NS, Canada
| | - Walter Somers
- Health Sciences Centre, Queen Elizabeth II Hospital, Halifax, NS, Canada
| | - Corry Collins
- CLU, Health Sciences Centre, Queen Elizabeth II Hospital, Halifax, NS, Canada
| | - Janet White
- Respiratory Therapy DGH, Health Sciences Centre, Queen Elizabeth II Hospital, Halifax, NS, Canada
| | - Olga Kits
- Research Methods Unit, Research, Innovation & Discovery, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, NS, Canada
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Richins MT, Gauntlett L, Tehrani N, Hesketh I, Weston D, Carter H, Amlôt R. Early Post-trauma Interventions in Organizations: A Scoping Review. Front Psychol 2020; 11:1176. [PMID: 32670143 PMCID: PMC7330139 DOI: 10.3389/fpsyg.2020.01176] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/06/2020] [Indexed: 12/02/2022] Open
Abstract
Background In some organizations, traumatic events via direct or indirect exposure are routine experiences. The National Institute for Health and Care Excellence reviews (2005; 2018) of post-traumatic stress disorder management in primary and secondary care did not address early interventions for trauma within emergency response organizations. Aims This scoping review was designed to identify research which evaluates the use of early interventions in emergency and other high-risk organizations following exposure to primary or secondary trauma and to report on the effectiveness of the early intervention models in common use. Methods A scoping review was conducted to examine early interventions for workers exposed to trauma, including emergency response, military, and humanitarian aid. Relevant data were extracted from the included studies and the outcomes were assessed using meta-ethnography. Results Fifty studies of mixed quality met the inclusion criteria for this review. A synthesis of study outcomes found that early interventions help emergency responders to manage post-incident trauma when they are delivered in a manner that (a) respects distinct organizational culture, (b) is supported by organizations and senior management, and (c) harnesses existing social cohesion and peer support systems within teams. Conclusion This review demonstrates that early interventions support emergency responders following exposure to trauma when these are tailored to the needs of the population, are supported by the host organization, and harness existing social cohesion and peer support processes within a team or unit. A number of recommendations for the delivery and evaluation of early interventions for psychological trauma in emergency response organizations were made.
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Affiliation(s)
- Matt T Richins
- Behavioural Science Team, Emergency Response Department Science and Technology, Health Protection and Medical Directorate, Public Health England, London, United Kingdom
| | - Louis Gauntlett
- Behavioural Science Team, Emergency Response Department Science and Technology, Health Protection and Medical Directorate, Public Health England, London, United Kingdom
| | - Noreen Tehrani
- Crisis, Disaster, and Trauma Section, British Psychological Society (Member of Standing Committee EFPA), Leicester, United Kingdom
| | - Ian Hesketh
- Alliance Manchester Business School, University of Manchester, Manchester, United Kingdom
| | - Dale Weston
- Behavioural Science Team, Emergency Response Department Science and Technology, Health Protection and Medical Directorate, Public Health England, London, United Kingdom
| | - Holly Carter
- Behavioural Science Team, Emergency Response Department Science and Technology, Health Protection and Medical Directorate, Public Health England, London, United Kingdom
| | - Richard Amlôt
- Behavioural Science Team, Emergency Response Department Science and Technology, Health Protection and Medical Directorate, Public Health England, London, United Kingdom
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Brooks SK, Dunn R, Amlôt R, Greenberg N, Rubin GJ. Training and post-disaster interventions for the psychological impacts on disaster-exposed employees: a systematic review. J Ment Health 2018:1-25. [PMID: 29447058 DOI: 10.1080/09638237.2018.1437610] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/15/2017] [Accepted: 01/18/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND When organisations are exposed to traumatic situations, such as disasters, often staff are not prepared for the potential psychological impact which can negatively affect their wellbeing. AIMS To conduct a systematic review of the literature on psychological interventions aimed at improving staff wellbeing during or after disasters. METHOD Four electronic literature databases were searched. Reference lists of relevant articles were hand-searched. RESULTS Fifteen articles were included. Five studies suggested that pre-disaster skills training and disaster education can improve employee confidence. Ten studies on post-disaster interventions revealed mixed findings on the effectiveness of psychological debriefing and limited evidence for cognitive behavioural therapy, psychoeducation and meditation. CONCLUSIONS Pre-disaster training and education can improve employees' confidence in their ability to cope with disasters. The routine use of post-disaster psychological debriefings is not supported; further research is needed to determine if debriefing interventions could be useful in some circumstances. Further research is needed to provide more evidence on the potential positive effects of cognitive behavioural therapy, psychoeducation and meditation. More experimental studies on psychological disaster interventions are needed.
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Affiliation(s)
- Samantha K Brooks
- a Department of Psychological Medicine , King's College London , London , UK , and
| | - Rebecca Dunn
- a Department of Psychological Medicine , King's College London , London , UK , and
| | - Richard Amlôt
- b Emergency Response Department Science and Technology, Health Protection Directorate, Public Health England , Salisbury , UK
| | - Neil Greenberg
- a Department of Psychological Medicine , King's College London , London , UK , and
| | - G James Rubin
- a Department of Psychological Medicine , King's College London , London , UK , and
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