When I say psychological debriefing

The impact of clearly defined debriefing practices on nurses working within an adult intensive care: A systematic review

OBJECTIVES

To critically analyse and synthesise the literature describing the relationship between a debriefing intervention and wellbeing in the distinct population of registered nurses working in the adult Intensive Care Unit (ICU).

METHODS

The JBI literature review methodology was used to analyse primary research exploring a clearly defined debriefing process with an aim to improving wellbeing in the setting and population of ICU nurses. A comprehensive search of primary research published between 1st January 2004 and 9th May 2024 was conducted. A systematic search was conducted across multiple scholarly databases: APA PsycInfo, CINAHL Complete, PubMed and Embase. Google Scholar and reference lists were also searched. Data from the included studies were extracted by one author, and then checked and verified by a second author. Included studies are summarised according to study details, debriefing characteristics and reported wellbeing results. Studies were appraised using the Mixed Methods Appraisal Tool.

RESULTS

The search yielded 732 articles, with 12 articles screened in full-text format. Three primary research studies met the inclusion criteria. All included studies utilised a mixed methods design, there was significant heterogeneity between logistical components of the debriefing intervention as well as study instruments and reporting.

CONCLUSION

This systematic review illustrates a paucity of available research on the specificity of debriefing practices and the potential relationship to wellbeing in the ICU nursing population.

IMPLICATIONS FOR CLINICAL PRACTICE

Further rigorous research is required surrounding the implementation and effectiveness of debriefing in the unique population of ICU nurses.

Responding to vicarious trauma experienced by junior doctors during hospital-based rotations: A narrative review considering effective approaches that have been used in healthcare settings

Transitioning from being a medical student to a junior doctor is stressful. Junior doctors must find ways to cope with unfamiliar clinical work in rapidly changing environments. Hospital-based placements can also expose junior doctors to vicarious trauma which cumulatively and disproportionately impacts the less experienced.ObjectivesPsychological debriefing continues to be implemented and advocated as a reactive approach to limit the effects of vicarious trauma. However, the literature strongly suggests this approach does not reduce the risk of developing post-traumatic stress disorder and may worsen symptoms. To identify alternatives to supporting junior doctors, a narrative literature search was conducted across multiple databases to identify relevant information. Alternatives to psychological debriefing included resilience training, mindfulness-based intervention, Schwartz rounds and somatic experiencing. While these novel interventions are promising, caution must be exercised, the evidence base is limited.ConclusionsExposure to distressing events may be unavoidable for junior doctors. As hospitals look for better ways to address vicarious trauma, caution must be exercised to follow the evidence rather than implement a solution-focused ideology that may be harmful. Our findings suggest the need to focus on proactive rather than reactive approaches. Further research is needed.

Understanding Intensive Care Unit Family Caregivers' Vulnerability to Post-Traumatic Stress Disorder: The Impact of Neurotic Personality Traits, Emotional Suppression, and Perceptions of Unexpected Death

Rationale: Family members of patients who die in an intensive care unit (ICU) are at heightened risk of post-traumatic stress disorder (PTSD) symptoms. Not all surrogates develop these symptoms and heterogeneity exists in PTSD symptom clusters. Objectives: The study tested a personality model of PTSD symptoms in bereaved family caregivers of ICU patients. It was hypothesized that family members endorsing higher levels of neurotic personality traits would report higher levels of PTSD symptom clusters and that these associations would be explained by tendencies to view the patient's death as unexpected and to cope by suppressing their emotions. Methods: Participants were family members of ICU patients at an urban, academic medical center who either died or were discharged to an inpatient hospice unit. Participants were contacted for participation at least six months after the patient's death. Participants completed measures of personality, emotion regulation, and PTSD symptoms. Data were analyzed using path analysis. Results: Approximately one-third (35%) of the sample of 162 caregivers endorsed at-risk levels of PTSD. Individuals reporting higher levels of neurotic personality traits reported more PTSD symptoms (r = 0.53, p < 0.001). Perceptions that the patient death was unexpected partially explained the association of neuroticism with the intrusive re-experiencing PTSD symptoms (B = 0.45, p = 0.031). In contrast, emotional suppression partially explained the association of neuroticism with avoidance (B = 0.70, p = 0.010) and hyperarousal symptom clusters (B = 0.37, p = 0.041). Conclusions: Family vulnerability to PTSD after an ICU death can be conceptualized based on neurotic personality traits. Tendencies to view the patient's death as unexpected may contribute to intrusive thoughts and memories of the ICU experience. Individuals may avoid reminders and remain at heightened levels of arousal when they suppress their emotional experiences. Key Message: Family members who experience the death of a loved one following ICU treatment are vulnerable to PTSD symptoms. These reactions to ICU-related losses may be shaped by family members' personalities, expectations, and emotion regulation styles. Understanding these characteristics could inform family screening and intervention efforts in the ICU.

What and when to debrief: a scoping review examining interprofessional clinical debriefing

INTRODUCTION

Clinical debriefing (CD) improves teamwork and patient care. It is implemented across a range of clinical contexts, but delivery and structure are variable. Furthermore, terminology to describe CD is also inconsistent and often ambiguous. This variability and the lack of clear terminology obstructs understanding and normalisation in practice. This review seeks to examine the contextual factors relating to different CD approaches with the aim to differentiate them to align with the needs of different clinical contexts.

METHODS

Articles describing CD were extracted from Medline, CINAHL, ERIC, PubMed, PsychINFO and Academic Search Complete. Empirical studies describing CD that involved two or more professions were eligible for inclusion. Included papers were charted and analysed using the Who-What-When-Where-Why-How model to examine contextual factors which were then used to develop categories of CD. Factors relating to what prompted debriefing and when debriefing occurred were used to differentiate CD approaches.

RESULTS

Forty-six papers were identified. CD was identified as either prompted or routine, and within these overarching categories debriefing was further differentiated by the timing of the debrief. Prompted CD was either immediate or delayed and routine CD was postoperative or end of shift. Some contextual factors were unique to each category while others were relatively heterogeneous. These categories help clarify the alignment between the context and the intention of CD.

CONCLUSIONS

The proposed categories offer a practical way to examine and discuss CD which may inform decisions about implementation. By differentiating CD according to relevant contextual factors, these categories may reduce confusion which currently hinders discourse and implementation. The findings from this review promote context-specific language and a shift away from conceptions of CD that embody a one-size-fits-all approach.

Experiences of medical students and nursing trainees from unexpected death through simulation training

BACKGROUND

Dying in simulation training is controversially discussed. On the one hand, the danger of an emotional overload of the learners is pointed out. On the other hand, dying in simulation settings is addressed as an opportunity to prepare future health professionals to deal with patient death. The present study investigates how medical students and nursing trainees experience the sudden death of a simulated patient and how and under which conditions it can be valuable to simulate the patient's death.

METHODS

At the TUM School of Medicine in Munich, Germany, we developed an interprofessional, simulation-based course in which participants were unexpectedly confronted with a cardiac arrest scenario within which resuscitation had to be discontinued due to an advanced directive. After the course, focus groups were conducted with nine medical students and six nursing trainees. Data were analysed using Grounded Theory techniques.

RESULTS

The participants reported low to high emotional involvement. The active renunciation of life-sustaining measures was felt to be particularly formative and caused a strange feeling and helplessness. Questions of what could have been done differently determined interviewees' thoughts. The participants appreciated the opportunity to experience what it feels like to lose a patient. The course experience encouraged interviewees to reflect on dying and the interviewees explained that they feel better prepared to face death after the course. The unexpected character of the confrontation, presence of the advanced directive and debriefing positively affected the impact of the simulation.

CONCLUSIONS

The study recognises simulation training as a promising approach for preparing future health care professionals to encounter a patient's death.