Timely Debriefing Proves to be Integral to Nurses' and Other Clinicians' Well-Being

A pediatric charge nurse struggled to cope with critical patient events. What resulted is a more effective debriefing process.

A charge nurse at a pediatric hospital who struggled to cope with several traumatic resuscitations within a short time frame helped create a tailored debriefing process that resulted in increased levels of compassion.

The bereavement/wellness committee in the pediatric intensive care unit (PICU) at Lurie Children’s Hospital of Chicago, of which the nurse was a co-chair, changed its debriefing process from one in which critical patient events were clinically reviewed days, or even weeks afterward, to one that gave those involved an opportunity to reflect on the event, recognize each other’s efforts, and, in the case of a death, honor the patient’s life, before the end of the current shift. 

One year after the Rapid Review of Resuscitation (R3) debriefing process was developed, staff compassion fatigue scores improved significantly, while levels of burnout and secondary traumatic stress were the same as before implementation, according to the article, Debriefing After Critical Events Is Feasible and Associated With Increased Compassion Satisfaction in the Pediatric Intensive Care Unit, published in the June issue of Critical Care Nurse (CCN).

“Many debriefing processes focus on communication and teamwork but neglect the emotional impact of critical patient events,” says co-author Courtney Nerovich, BSN, RN, a nurse in the PICU and a member of the committee. “We specifically added elements to reflect, to honor the patient’s life and recognize the team’s efforts.”

“These additions may have enhanced clinician, patient, and team connections while supporting mindfulness and reflection,” Nerovich says.

Changing the process

Before the R3 implementation, the standard practice at the 40-bed, high-acuity, high-volume PICU was to hold an event debriefing several days to weeks after a traumatic event. The process was inconsistent and often had poor attendance.

Additionally, staff members were leaving work with significant distress after critical events, the article notes.

“The team’s objective was to create a sustainable debriefing process that allowed time for reflection and encouraged team communication after critical patient events,” according to the article.

The team conducted a literature review along with several individual staff interviews, in which staff members identified talking with colleagues as a primary method for coping and expressed a desire for a more consistent mechanism to process critical patient events.

The team then created a single-page debriefing guide with scripted language and open-ended questions. The guide included three essential process components that aligned with staff needs:

• A review of the patient event and team dynamics.
• Acknowledgement of the event’s emotional impact on staff.
• For events in which the patient died, a moment of reverence to honor the patient’s life.

The team sought feedback, which led to minor adjustments to the initial debriefing process, including development of a guide specific to the planned withdrawal of life-sustaining therapies, which was called R3-D.

The R3 process was designed to be completed voluntarily before the end of the shift with the expectation that after a critical patient event, an R3 champion would contact the primary medical team and determine a time to conduct a debriefing during the current shift, if possible.

Once the debriefing was scheduled, the champion would notify all staff members who were directly or peripherally involved in the event, with the goal of including as many of them as possible. During the debriefing, the champion read the guide and recorded the team’s responses, the article says.

“In the 12 months after implementation of the new process, the debriefings were integrated into the PICU culture and became expected and valued by staff,” the article reads. “It has since been implemented on other inpatient care units and has received overwhelmingly positive feedback.”