Matter for discussion, submitted by the RCN North West Outer London Branch
That this meeting of Congress considers that nurse debriefing is crucial after each shift.
Debriefings originated in the military and are a process of reviewing information and performance, with opportunities to assess activity once participation is complete. In addition to military debriefing, types of debriefing include experiential learning, crisis intervention, psychological debriefing and critical incident stress debriefing. There has been widespread debate around debriefing following traumatic events and the usefulness in day-to-day practice across a wide range of settings. Working in areas such as emergency departments and in critical care areas, nurses are exposed to traumatic events, witnessing death, the effects of child abuse and aggression and violence.
Timely debriefing in health care is essential as it enhances the nurses and other team members’ ability to deal with such events, as well as to challenge what happened during the shift, especially if there has been an incident involving serious injury or death. Debriefing can reduce the possibility of psychological harm by talking about what has happened; facts can be reviewed, misconceptions corrected, as well as valid and fair observations taken on board. Thus the information can be used to analyse the critical event and help prevent further untoward incidents. Even in the absence of an actual traumatic event, debriefing takes into account a stressful work environment and provides a valuable opportunity to share thoughts, feelings and experiences.
Debriefing can foster relevant and timely discussion in a non-threatening and non-judgemental fashion. It is especially useful for those nurses who have experienced difficult situations but are reluctant or simply apathetic to talk about them.
Healthcare Improvement Scotland (HIS) supports delivery of the Scottish Patient Safety Programme which includes the concept of the safety huddle involving all members of the multidisciplinary team, including nursing, getting together to review patients in their care at several points in the day.
The Nurse Staffing Levels Act (Wales) 2016 aims to ensure that the number of level one nurse registrants on duty enables the provision of safe nursing care, in conjunction with enabling nurses to access the resources they need to provide it, including the required level of supervision, mentorship, coaching and other interventions supported by the evidence base.
Patient care has become increasingly complex, raising many problems, and nurses may avoid talking about them fearing repercussions. Debriefing can help staff engage in true reflective practice to scrutinise and examine assumptions in professional work practices and seek practical solutions. It can be a mechanism whereby nurse leaders can actively support frontline practitioners experiencing difficult situations.
Debriefing started in the military as a way of checking facts and reflecting on outcomes. Nurses deliver care on the frontline under challenging circumstances and Zeba Arif, proposer of this agenda item, asked Congress “Is debriefing essential, crucial, relevant?”
While events are documented they may not be talked about. Zeba went on to say “debriefing affords nurses with an opportunity to share thoughts, feelings or experiences” in a non-threatening way which ultimately improves wellbeing, promotes compassionate care and increases transparency.
Helen O’Boyle, North Central Inner London Branch stated she works in ICU and debriefs usually occur after an incident which is “really important and useful” but she queried whether it should happen after the end of each shift. This was reinforced by Maura Buchanan who said it wasn’t practical after each shift and mentioned partial debriefing as an option.
Members agreed events can be challenging and traumatic for nurses and that debriefing can identify areas for improvement, help team work and help alleviate the emotional impact on the staff involved.
Chloe Scotford, Wiltshire Branch spoke of her own experience as a newly qualified nurse where she witnessed a child in cardiac arrest in a trauma unit in A&E. She said it was really difficult to see and she went home wanting to cry and “give up on her career”. What helped her was talking to her line manager, creating learning events and speaking at team meetings.
Denise Chaffer stated nurses need to be proactive not just reactive and said “briefings and safety huddles are as important as debriefings”. She concluded “we can’t continue to have an environment where nurses are feeling unsupported or not listened to”. We should move away from blame and towards learning.