Debriefing after a crisis

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Moral distress … It surfaces, especially in high-stakes, high-stress healthcare settings. Research shows that nurses who experience moral distress in their work setting without receiving situational support aren't able to easily process the experience.1 Nurses who eventually resolve their moral distress alone may take longer than a year to do so.1Whereas dramatic, “newsworthy” events trigger an outpouring of support for workgroups, the daily, less dramatic but morally draining events that nurses face often remain unacknowledged. Employees may benefit from brief interventions, called debriefing or critical incident stress debriefing (CISD), when exposed to a traumatic event.2 Leadership initiative is needed to bring together staff members to acknowledge shared distress, to accept responses to that distress, to affirm the group's human suffering, and to help the group cope.4The processDebriefing is an information-sharing and event-processing session conducted as a conversation between peers. Group members become informants to each other about a situation or event that occurred to them as a group. The listener can be a therapist, counselor, or professional peer who helps the group process the information being shared. The person who conducts the session should have the professional skills to guide the established process that will help staff members recover from their distress. An important aspect of debriefing is that the leader will assess the need for individuals who might benefit from further individual counseling and will make recommendations for individual follow-up.2How can a manager recognize the need for debriefing? The staff's mood can provide a clear indication about the type and level of distress being experienced. Whether the experience of distress is moral, emotional, psychological, or spiritual in nature, if it's occurring within the group as a whole, the whole group needs affirmation and support.First, there can be a somber mood with signs such as an unusual quietness, less conversation, less responsiveness to each other and to patients, less expressed interest in each other, and obvious signs of sadness such as frequent sighing or easy tearfulness. The event itself canbe obvious, one in which the manager was directly involved. Rarely, it's obscure, such as an external event about which the manager has no direct knowledge.Keeping a finger on the pulse of the staff as a group is an important managerial responsibility. Whenever a critical incident has occurred, debriefing should follow as soon as possible. Yet, debriefing isn't the answer to every problem, because not every problem that occurs in the workplace is a critical incident.What's a critical incident?Events that would garner this kind of attention and intervention include episodes of workplace violence or terrorism, industrial accidents, or other events of a serious nature. Yet, the healthcare environment is replete with examples of critical incidents that aren't newsworthy, as they're protected from public disclosure by patient confidentiality. For example, adverse drug reactions that have led to the unanticipated death of patients must be reported to federal and state agencies. These agencies are responsible to safeguard public safety by releasing general information as warnings, but wouldn't release specific details to the media that could compromise a particular patient's right to confidentiality about medical treatment. Yet, a healthcare worker who gave a fatal dose of properly prescribed and administered medication to a patient would be involved in a critical incident of great magnitude given the loss of life.In healthcare, there are additional examples of critical incidents that aren't as serious as the actual loss of a patient's life, but these are events that can disturb the sense of peace and purpose of healthcare workers.

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