In support of appropriate psychological debriefing

Critical Incident Stress in Healthcare Education: An Integrative Review

BACKGROUND

Healthcare professionals' repeated exposure to critical incidents can cause various physical and psychological symptoms with potentially severe personal and professional consequences. Healthcare students' exposure to critical incidents begins during their clinical education. Despite known consequences, healthcare education has yet to implement a standardized approach for preparing students for critical incidents. Critical incident stress management, one identified program, has been utilized in healthcare organizations. However, formal critical incident stress management programs may not be appropriate for healthcare education with requirements to educate students on the clinical knowledge, skills, and judgment needed during critical incidents.

PURPOSE

The purpose of this review was to determine the state of the science related to critical incident stress in the context of healthcare education.

METHODS

A literature search was conducted, and peer-reviewed articles were included.

RESULTS

Four articles were identified for inclusion, signaling a need for more research on critical incident stress in healthcare education.

CONCLUSIONS

The available literature suggests that students are impacted by critical incident stress. The studies in this review did not incorporate critical incident stress or components of critical incident stress management programs into their overall curricula or educational programs. The studies did demonstrate that students may be positively or negatively influenced by critical incident stress. Critical incident stress programs are not widely incorporated into healthcare education; however, it has been demonstrated that a standardized approach to preparing and supporting students is needed. Future studies need to determine if critical incident stress should be integrated into healthcare education and the outcomes.

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.

Considerations for Psychological Debriefing in the Context of Prolonged Disaster Response

First responders face greater exposure to potentially traumatic events compared with the general public, which can lead to an increased likelihood of developing mental health concerns. The challenges of disaster relief take a physical and mental toll on first responders. Critical incident stress debriefing (CISD), the widely accepted gold-standard treatment for psychological debriefing, is often applied to offset this toll among first responders. CISD is a manualized seven-stage group intervention that was developed to provide support and aid in coping and to allow individuals who respond to emergencies and disasters to continue working. Substantial evidence has been found for its effectiveness. However, there is a general dearth of evidence about the field of prolonged disaster response, and research is hampered by the difficulties of executing a controlled study in the context of an emergency scenario.

Exploring the experiences and perceptions of trainees undertaking a critical incident debrief training programme: A qualitative study

RATIONALE, AIMS AND OBJECTIVES

Critical incident debriefing is an occupational health tool for supporting healthcare workers following critical incidents. Demand for debriefing has increased following the Covid-19 pandemic. There is now a need for more trained debrief facilitators to meet demand, but there is a dearth of literature regarding how best to train facilitators. This study addressed this by exploring participant experiences of an online critical incident debrief training programme.

METHODS

We conducted semi-structured interviews with 14 individuals who received a 5-day training programme based on the Critical Incident Stress Management model. Participants were recruited from a range of professional disciplines including psychology, nursing and human resources within one British healthcare system. Data were analysed using thematic analysis.

RESULTS

The analysis produced three themes. Managing trainee experiences and expectations suggested that disciplinary heterogeneity in training groups supported inter-participant knowledge exchange. However, this variation also meant that training materials did not meet the learning needs of all participants. Modality of training suggested that while online learning was acceptable for some, others experienced screen fatigue and found it hard to build rapport with other participants. Systematic and organisational obstacles to training access and delivery suggested that lack of managerial support and organisational mental health stigma may be barriers to accessing training.

CONCLUSION

A 5-day online CISM-based training programme was acceptable to participants. Organisations implementing critical incident debrief training may benefit from (1) offering both in-person and online training options, and (2) tailoring course materials according to the disciplinary make-up of groups.

Revisiting the debriefing debate: does psychological debriefing reduce PTSD symptomology following work-related trauma? A meta-analysis

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.

Evaluation of a training programme for critical incident debrief facilitators

BACKGROUND

Critical incident debriefs are a commonly used occupational health tool for supporting staff after traumatic work incidents. However, there is a dearth of literature evaluating training programmes for debrief facilitators.

AIMS

To evaluate a 5-day training programme to equip healthcare, social care and voluntary, community and social enterprise sector staff to act as post-incident peer supporters and debrief facilitators.

METHODS

A mixed-methods, single-arm, before-and-after study. Data were collected at baseline and post-training. The quantitative outcome measure was 'Confidence'; the sum of two items measuring confidence in (i) supporting peers after critical incidents and (ii) facilitating post-incident structured team discussions. At post-training, quantitative and qualitative feedback regarding experiences and perceptions of the training was also gathered.

RESULTS

We recruited 45 participants between October 2021 and January 2022. Confidence in supporting peers following incidents and facilitating post-incident structured team discussions increased significantly following the training, t(35) = -6.77, P < 0.001. A majority of participants reported they would do things differently because of the training and that they found the training relevant, useful and engaging. Summative content analysis of qualitative feedback indicated that participants (i) believed the role plays were an important learning tool and (ii) thought it was important that the trainer was engaging. Some participants would have preferred in-person delivery.

CONCLUSIONS

Participants valued training in post-incident peer support and debriefing skills. Organizations implementing post-incident support pathways could usefully include this training and ensure optimal uptake and engagement by (i) providing in-person and online delivery options and (ii) including role play as a learning technique.