Debriefing in Nursing

Case Study 

Mr. S was a 60-year-old man who as an unrestrained driver was involved in a car crash. He sustained various injuries: concussions, left pneumothorax, multiple fractures including lumbar spine, left rib, and pelvis fractures. The fractures were complicated by high alcohol intoxication level (229mg/dl blood alcohol level). The client had a past surgical and medical history of splenectomy. I met Mr. S after his admission to the surgical trauma ICU where he was observed and later transferred to a lesser intensive care level. There was the placement of left chest tube which was then removed after a decrease in output. 

The team that was taking care of Mr. S initiated his discharge. However, Mr. S refused to take part in physical therapy where he preferred not to get out of bed. I was in charge of Mr. S, and as a nurse, it was my duty to assist him in his physical therapy. It was hard to engage Mr. S in any of the therapy due to his incessant foul language, inconsistent responses, and belligerent demands. He was repugnant to my sensitivity, objectionable, and distasteful to me as his nurse attendant. 

While taking his social history, he gave different answers of where he lived. He stated he was a widower without siblings and children giving an appearance that he was alienated from all family members. Due to his inconsistency in giving history information, I suspected that he was either fabricating or withholding his past information. On his 6^th day in the hospital, a chest CAT was performed which revealed a loculated hematoma due to retained hemothorax. This led to the recommendation of another chest tube. However, after discussing the benefits and the risks of the procedure, the client adamantly refused, “I don’t need any tube in my chest and just give me two days to resolve the issue” from a functional standpoint, he was making a little progress, and with reasonable assistance, he was ambulating. 

He maintained his stand even after an explanation from the surgeon that delay would increase chances of open chest surgery as well as renal and respiratory failure, sepsis, heart attack, or even loss of life. With all the warnings, Mr. S refused either due to abstinence or lack of understanding. His behavior led me to suspect that the client lacked the capacity to make any decisions concerning his health where I consulted the Behavioral Medicine for evaluation where they guaranteed that he did not have the capability to understand the intensity of his current medical issue. Due to all the above, his condition deteriorated and was transferred to ICU for life-saving procedures.

The Effect of the Case to my Career

I met Mr. S barely two years into my practice. This case was the foundation of my practice as a nurse. It is from Mr. S that I learned and understood patient-centered care. As explained by Rynolds (2009), patient-centered care focuses on a client and his/her specific health care needs. Its goal is to empower the client to be actively involved in their health. Mr. S was given a chance to choose and make decisions concerning his health condition. This is one fundamental factor that nurses grant to all patients. 

However, due to some psychological issues, this led to ethical dilemmas that led to involvement of Behavioral Medicine. Nevertheless, the participation of the group was done late and led to more complications on the health of Mr. S. Therefore; this case was stressing to me as his nurse in charge. Additionally, it was a crucial case in my career that has impacted on my provision of patient-centered care, especially while dealing with difficult patients and ethical considerations.

Steps Taken

After the incidence, I was called for a debriefing together with other medical personnel by the management. The team assisted us in moving on from such an incident while highlighting on the best technique to deal with such cases. The team explained that as a practicing nurse, it is important to incorporate all the Picker’s eight principles of patient-centered care. They include respecting the preference of a client, integration and coordination of care, education and information, physical comfort, emotional support, family involvement, continuity and transition, and access to care. The principles are the guidelines that have assisted me care of patients. After reviewing the incident, it was possible to improve my efficiency and provide the best nursing care to clients.

Importance of Medical Debriefings

In nursing and health professions, debriefing is a general retrospective analysis for critical incidences. It assists in the reduction of stress through structured discussions. It assists in the review of the event and discussing the response of staffs. As discussed by Shinnick, Woo, Horwich, and Steadman (2011), it acts as an opportunity for health professionals to communicate without pressure and stress of being in the act. The review assists in identifying what went wrong while identifying areas that require being improved. This is essential as it helps employees to develop ways of enhancing communication and facilitating teamwork during a crisis.

Debriefings are also important as they help nurses to talk about work and their feelings through emotions.  Shinnick, Woo, Horwich, and Steadman (2011) explain that although medical personnel are accustomed to life-threatening situations, they are humans. Due to their human nature, they may be affected by disturbing, tragic, or sad events. In such cases, a debriefing is a way that assists health professionals to get things off their chest by talking to others who understand the situation and can give them support.

In the health facility I work in, debriefing is carried out. However, it is not a continuous assessment and requires to be structured. This will enable the possibility of including debriefing as an everyday tool to assist in giving support not just to nurses but to all health care personnel. Debriefing rules need to be discussed to help participants understand the process. The process should be a platform that explains the feelings of participants and should not be used to assign blame or point fingers.

Debriefing in my place of work may either be conducted by a physician, clinical coordinator, or a nursing supervisor. The participants should include all the personnel who participated in the event, either a code of blue or another momentous event. The facilitator should introduce the process, what occurred and the response that the team members illustrated. They discuss all the situation’s facts. The facilitator then gives all the participants a chance to discuss and share information. The facilitator should encourage the participants to share their thoughts and talk about their feelings. 

Mostly, the debriefing takes place in the health facility in one of its meeting halls. The staff and facilitators should determine any procedures that would have been done differently in improving the client’s outcome. The organizer gives the participants a chance to ask questions or improve recommendations. The facility may also include support staff in the debriefing process. Some of the support staff may include chaplains, social workers, and counselors. Although these individuals may not discuss specific health aspects of the state of affairs, they can play a vital role in the debriefing process. For example, counselors or social workers may assist participants with suggestions and ideas to deal with emotional issues after death or tragic events.

Debriefing would assist the staff to have time to process the event and work through negative feelings. If negative emotions are allowed to build up, the nurses and other health personnel may find themselves burnt out or overwhelmed. Therefore, as stated by Hanna and Romanna (2007), learning stress coping strategies and ways of dealing with adverse patient outcomes assists the healthcare personnel including nurses throughout their careers. Although a medical briefing is not an individual counseling session, it assists nurses to talk and open up about the personal impact of traumatizing events they experience in their day to day life. The process is also essential to facilitators or supervisors as it assists them in identifying nurses who have are havomg a hard time dealing with the event, where they are referred to relevant departments for assistance. Therefore, debriefing process is not only essential to the practicing nurse, physicians, or clinicians, but also assists in improving the care of patients and creating a sense of comradery and teamwork.

Reference

Hanna, D., & Romanna, M. (2007). Debriefing after a Crisis (1st ed.). Retrieved from http://www.bhs.org.au/sites/default/files/finder/pdf/cnhe/journal%20club/2008/LeadingOpinions200802.pdf

Reynolds, A. (2009). Patient-centered care. Radiologic Technology, 81(2), 133-147.Shinnick, M. A., Woo, M., Horwich, T. B., & Steadman, R. (2011). Debriefing: The most important component in simulation?. Clinical Simulation in Nursing, 7(3), e105-e111.