the use of debriefings for caregiver stress
DESCRIPTION
The Use of Debriefings for Caregiver Stress. Marcie Peterson, MSN, RN, CCRN, CNML Children’s Hospital & Medical Center April 16 th , 2012. Have you ever…. Struggled with leaving work at work Performed a clinical assessment Lost a patient Become too attached - PowerPoint PPT PresentationTRANSCRIPT
The Use of The Use of Debriefings for Debriefings for
Caregiver Stress Caregiver Stress
Marcie Peterson, MSN, RN, CCRN, CNMLMarcie Peterson, MSN, RN, CCRN, CNML
Children’s Hospital & Medical CenterChildren’s Hospital & Medical Center
April 16April 16thth, 2012, 2012
Have you ever…Have you ever…
Struggled with leaving work at workStruggled with leaving work at work
Performed a clinical assessment Performed a clinical assessment
Lost a patientLost a patient
Become too attachedBecome too attached
Felt like you were doing more harm Felt like you were doing more harm than goodthan good
As Nurses… As Nurses…
Repeated exposureRepeated exposure
Hear the stories by those we helpHear the stories by those we help
We absorb other people’s lossesWe absorb other people’s losses
Comfort our patients & families in need Comfort our patients & families in need
“The expectation that we can be immersed in suffering and loss and not
be touched by it is as unrealistic as expecting to be able to walk through
water without getting wet.”
~ Rachel Naomi Remen, 1996
How does all of this How does all of this affect us?affect us?
Work EnvironmentWork Environment
TeamTeam
Experience levelExperience level
RelationshipsRelationships
Spiritually Spiritually
How do we COPE???How do we COPE???
DebriefingDebriefing
A conference or discussion held with A conference or discussion held with the team after an intense event or the team after an intense event or catastrophe; all aspects of the event catastrophe; all aspects of the event are discussed and analyzedare discussed and analyzed
A process where support is given to A process where support is given to groups or individuals who have groups or individuals who have experienced an extraordinary clinical experienced an extraordinary clinical event that has the potential to cause event that has the potential to cause unusually strong emotional reactionsunusually strong emotional reactions
History History
Developed by Jeffrey T. Mitchell in 1974Developed by Jeffrey T. Mitchell in 1974
First used with small groups of First used with small groups of paramedics, firefighters, and law paramedics, firefighters, and law enforcement officersenforcement officers
Over time, debriefings spread to the Over time, debriefings spread to the military services, airlines, railroads, and military services, airlines, railroads, and hospitals hospitals
The Importance of The Importance of DebriefingsDebriefings
Patient Safety Patient Safety Clear thinking is essential for overcoming the Clear thinking is essential for overcoming the
chaotic and stressful environment in which chaotic and stressful environment in which patient care teams operatepatient care teams operate
Shared Understanding Shared Understanding Has developed during debriefings to improve Has developed during debriefings to improve
team performanceteam performance
Gained InsightGained Insight Use knowledge from past experience to Use knowledge from past experience to
improve future performance improve future performance
The Importance of The Importance of DebriefingsDebriefings
GuiltGuilt Individual team members may feel responsible Individual team members may feel responsible
for the eventfor the event
Coping SkillsCoping Skills Teams learn practical applications to assist in Teams learn practical applications to assist in
dealing with difficult situations in the futuredealing with difficult situations in the future
CommunicationCommunication Teams can develop new communication Teams can develop new communication
methods or strategies to use during methods or strategies to use during subsequent events. subsequent events.
12 Evidence-Based Best 12 Evidence-Based Best Practices Practices
1.1. Must be diagnosticMust be diagnostic
2.2. Create a supporting learning environmentCreate a supporting learning environment
3.3. Encourage team to be attentive of teamwork Encourage team to be attentive of teamwork process during performanceprocess during performance
4.4. Educate Facilitators/Leaders on the Art & Educate Facilitators/Leaders on the Art & Science of leading debriefingsScience of leading debriefings
5.5. Team members feel comfortableTeam members feel comfortable
6.6. Focus on a few critical performance issuesFocus on a few critical performance issues
Joint Commission Journal on Quality and Patient Safety, 2008Joint Commission Journal on Quality and Patient Safety, 2008
12 Evidence-Based Best 12 Evidence-Based Best Practices Practices
7.7. Describe specific teamwork interactions & processesDescribe specific teamwork interactions & processes
8.8. Support feedback with objective indicators of Support feedback with objective indicators of performanceperformance
9.9. Provide outcome feedback later and less frequently Provide outcome feedback later and less frequently than process feedbackthan process feedback
10.10. Provide both individual & team-oriented feedbackProvide both individual & team-oriented feedback
11.11. Shorten the delay between task performance and Shorten the delay between task performance and feedbackfeedback
12.12. Record conclusions made and goals set Record conclusions made and goals set
Joint Commission Journal on Quality and Patient Joint Commission Journal on Quality and Patient Safety, 2008Safety, 2008
Goals to Conduct a Goals to Conduct a DebriefingDebriefing
Identify the nature of the problemIdentify the nature of the problem
Review why…how…and what resultedReview why…how…and what resulted
Allow team members to discussAllow team members to discuss The decisions made during the eventThe decisions made during the event What could have been done differentlyWhat could have been done differently
• MiscommunicationMiscommunication• Unprofessional behaviorUnprofessional behavior
The need for remediation or trainingThe need for remediation or training Identify success and the positives which came Identify success and the positives which came
out of the eventout of the event
TimingTiming
Timing is Timing is ESSENTIALESSENTIAL!!!!!! Should occur shortly after the incidentShould occur shortly after the incident Within 24 to 72 hours Within 24 to 72 hours
Tools Used for Tools Used for DebriefingsDebriefings
Critical Incident Stress DebriefingCritical Incident Stress Debriefing
The MEND ProcessThe MEND Process
The Calling CircleThe Calling Circle
Critical Incident Stress Critical Incident Stress DebriefingDebriefing
Phase1
INTRODUCTION
Phase2
FACTS
Phase3
THOUGHTS Phase
4REACTIO
NS
Introduction PhaseIntroduction Phase
Team members introduce themselvesTeam members introduce themselves
Clarify the goals Clarify the goals
Team leader encourages each member Team leader encourages each member to speak to speak
The team leader reminds the members The team leader reminds the members what is discussed during the meeting what is discussed during the meeting is confidential is confidential
Fact PhaseFact Phase
Extremely brief overview of the critical Extremely brief overview of the critical incident is discussed and the role each incident is discussed and the role each team member participated in during the team member participated in during the critical event critical event
Excessive detail is discouraged Excessive detail is discouraged
Everyone is given an opportunity to Everyone is given an opportunity to speakspeak Decreases anxiety levels among the membersDecreases anxiety levels among the members Shows the group they are in control of the Shows the group they are in control of the
discussion discussion
Thoughts PhaseThoughts Phase
Discuss individuals thoughts about the Discuss individuals thoughts about the critical incidentcritical incident
Important not to discuss the painful Important not to discuss the painful aspects of the event in the beginning aspects of the event in the beginning of this phase of this phase
Reaction PhaseReaction Phase
The heart of Critical Incident Stress The heart of Critical Incident Stress DebriefingDebriefing
Focuses on the impact the stressful Focuses on the impact the stressful event had on the team membersevent had on the team members
Each member is encouraged to discuss Each member is encouraged to discuss their reaction to the eventtheir reaction to the event
Symptom PhaseSymptom Phase
Team members may or may not have Team members may or may not have symptoms related to the stressful symptoms related to the stressful event which occurred event which occurred
The team leader asks the members The team leader asks the members about cognitive, physical, emotional, or about cognitive, physical, emotional, or behavioral symptoms the team behavioral symptoms the team members may be experiencingmembers may be experiencing
Teaching PhaseTeaching Phase
Team leader discusses the symptoms Team leader discusses the symptoms team members may be feeling and team members may be feeling and provides them with explanationsprovides them with explanations
Other topics may be discussed during Other topics may be discussed during this phase if teaching is necessary to this phase if teaching is necessary to help the team membershelp the team members
Re-Entry PhaseRe-Entry Phase
Team members are encourage to ask Team members are encourage to ask any remaining questionsany remaining questions
Final statements or comments are made Final statements or comments are made
The team leader summarizes the The team leader summarizes the meetingmeeting
Final explanations, information, Final explanations, information, guidance, and thoughts are presented to guidance, and thoughts are presented to the groupthe group
The Unexpected Case The Unexpected Case ReviewReview
The MEND ProcessThe MEND Process
Tool for leaders to provide support and Tool for leaders to provide support and resources to their staffresources to their staff
Healthcare providers are our greatest Healthcare providers are our greatest assetasset
Paramount to the success and growth of Paramount to the success and growth of our organizationour organization
Children’s Hospital of Wisconsin in Milwaukee Children’s Hospital of Wisconsin in Milwaukee
MENDMEND
M - M - Meet with the employee 1:1 in a private areaMeet with the employee 1:1 in a private area
E - E - Explore the situation Explore the situation
N - N - Normalize their feelings and response to the Normalize their feelings and response to the event event
D - D - Discuss resourcesDiscuss resources
Children’s Hospital of Wisconsin in MilwaukeeChildren’s Hospital of Wisconsin in Milwaukee
Individual Case ReviewIndividual Case Review
The Calling CircleThe Calling Circle
A circle is participatory in nature, small A circle is participatory in nature, small enough to serve as a workable council, enough to serve as a workable council,
and diverse enough to address whatever and diverse enough to address whatever exists within the reach of its purpose.exists within the reach of its purpose.
C. Baldwin & A. LinneaC. Baldwin & A. Linnea
Three Principles of the Three Principles of the CircleCircle
Leadership is rotatingLeadership is rotating
Responsibility is sharedResponsibility is shared
Reliance is on the spirit of the group: Reliance is on the spirit of the group: Clarified intentionClarified intention Common purpose or highest goalsCommon purpose or highest goals
C. C.
Baldwin & A. LinneaBaldwin & A. Linnea
Three Practices of Three Practices of CouncilCouncil
Attentive listeningAttentive listening
Intentional speakingIntentional speaking
Conscious self-monitoringConscious self-monitoring
C. Baldwin & A. LinneaC. Baldwin & A. Linnea
Shared LeadershipShared Leadership
The Council AgreementsThe Council Agreements:: What is said in the circle belongs to that circleWhat is said in the circle belongs to that circle We listen to each other with discernment, not We listen to each other with discernment, not
judgmentjudgment Each person asks for the support he/she needs Each person asks for the support he/she needs
and offers the support he/she canand offers the support he/she can When the group is uncertain how to proceed, or When the group is uncertain how to proceed, or
in need of a resting point in group process, we in need of a resting point in group process, we will stop action, observe a pause and self reflect will stop action, observe a pause and self reflect
C. Baldwin & A. LinneaC. Baldwin & A. Linnea
The Components of the The Components of the CircleCircle
Start pointStart pointSetting the centerSetting the centerAgreementsAgreementsCheck-inCheck-inThree PrinciplesThree PrinciplesThree PracticesThree PracticesGuardianGuardianCheck-outCheck-out
C. Baldwin & A. LinneaC. Baldwin & A. Linnea
End of Life Case ReviewEnd of Life Case Review
EnvironmentEnvironment
Non-threatening Non-threatening
Contributions provided are seen as Contributions provided are seen as developmental feedback and not as developmental feedback and not as criticism or to blame the individual criticism or to blame the individual
The team seated in a circleThe team seated in a circle
Isolated and quiet spaceIsolated and quiet space
FeedbackFeedback
Most crucial element of learningMost crucial element of learning
Leaders must be specific, objective, Leaders must be specific, objective, and honest when identifying indicators and honest when identifying indicators of performance of performance
Feedback can be Feedback can be Individually focused or Individually focused or Team focused Team focused
Team FeedbackTeam Feedback
Situation assessmentSituation assessment
Supporting behaviorSupporting behavior
CommunicationCommunication
Leadership or initiativeLeadership or initiative
Facilitators & LeadersFacilitators & Leaders
Guide the team in the self-corrective Guide the team in the self-corrective process byprocess by Providing positive and negative examples Providing positive and negative examples
of each teamwork componentof each teamwork component Provide actual and potential impacts of Provide actual and potential impacts of
these behaviors on performance outcomesthese behaviors on performance outcomes Provide solutions to each problem Provide solutions to each problem
identified identified
Do NOT…Do NOT…
Fail to protect or block members from Fail to protect or block members from harmful disclosuresharmful disclosures
Force active participation before a Force active participation before a team member is ready to do so. team member is ready to do so.
Encourage confrontation and Encourage confrontation and expression of anger from team expression of anger from team membersmembers
Pressure members to accept unwanted Pressure members to accept unwanted feedback or demands for changefeedback or demands for change
The Role of Facilitator & The Role of Facilitator & LeaderLeader
Understand the principles of group Understand the principles of group dynamicsdynamics
CareCare
Manage ethical issuesManage ethical issues
Build cohesion among the team Build cohesion among the team membersmembers
“Only when nurses take time to heal themselves can they truly be available to aid in the healing of
others.”
Bush, 2009
ReferencesReferences Bush, N.J. (2009). Compassion fatigue: Are you at risk. Bush, N.J. (2009). Compassion fatigue: Are you at risk. Oncology Oncology
Nursing Forum Nursing Forum 36(1), 24-28.36(1), 24-28.
Mitchell, J.T. Critical incident stress debriefing. Mitchell, J.T. Critical incident stress debriefing. Trauma. Trauma. Retrieved Retrieved from from www.infor-trauma.org
Nachshoni, T., Knobler, C.H.Y., Jaffe, E., Peretz, M.G., & Yehuda, Y.B. Nachshoni, T., Knobler, C.H.Y., Jaffe, E., Peretz, M.G., & Yehuda, Y.B. (2007). Psychological guidelines for a medical team debriefing after (2007). Psychological guidelines for a medical team debriefing after a stressful event. a stressful event. Military Medicine, 172,Military Medicine, 172, 581-585. 581-585.
Pender, D.A., & Prichard, K.K. (2009). ASGW best practice guidelines Pender, D.A., & Prichard, K.K. (2009). ASGW best practice guidelines as a research tool: a comprehensive examination of the critical as a research tool: a comprehensive examination of the critical incident stress debriefing. incident stress debriefing. The Journal for Specialists in Group Work, The Journal for Specialists in Group Work, 3434(2), 175-192. (2), 175-192.
Salas, E., Klein, C., King, H., Salisbury, M., Augenstein, J.S., Birnbach, Salas, E., Klein, C., King, H., Salisbury, M., Augenstein, J.S., Birnbach, D.J., . . . Upshaw, C. (2008). Debriefing medical teams: 12 evidence-D.J., . . . Upshaw, C. (2008). Debriefing medical teams: 12 evidence-based best practices and tips. based best practices and tips. Joint Commission on Accreditation of Joint Commission on Accreditation of Healthcare Organization, 34Healthcare Organization, 34(9), 518-527(9), 518-527
Tamm, W. J. & Luyet, J. R. (2004). Radical Collaboration. New York: HarperCollins Publishers.