Capstone Proposal: Implementing Debriefing Following Codes
Debriefing after codes determines areas of excellence as well as areas of improvements that the concerned teams out to dwell on. Implementation of the process requires a well laid down strategy that can see the process excel in all the settings that are interested in using the process.
Background
Gynecological cancer hospital cancer unit which forms the area of practice encompasses the provision of a range of services. These activities entail screening of cancers, treatment of cancer patients and providing palliative care for the terminally ill patients with cancer. With the incident rate and prevalence of the condition globally, the unit is usually busy with services being offered at different parts. For a reasonable period, nurses within the unit engage in providing to care to patients especially at their terminal stages up to their periods of death. Due to the chronic nature of the condition, the service provision is ever stressful not only to the nurses but also to the family members who commit towards providing support to their loved ones (Calton et al., 2016). In the case of code events, the attachment is usually lost with both the care providers experiencing moments of stress. In response to this state, the unit suggested the development of a debriefing process that was geared towards managing various significant events including code events. This process, however, led to the proposal that aims at implementing the debriefing process after codes within the unit.
Problem statement
The palliative care at the cancer hospital unit is always intensive subjecting the care provides to numerous instances of stress and burnout. Also, the terminal cases that usually require intensive care with situations of significant events such as deaths also mount much psychological impact to the families and the nurses as well. With a good number of patients undergoing palliative and existence of many code events following the peaceful death from nursing care, the nurses and the significant others to patients experiences stressful moments. These experiences require intervention to allow the family and the care providers to get back to their usual duties. This can solely be achieved by taking them through a review process of the events so that they can share their experiences and concerns.
Purpose of the change proposal
The implementation of debriefing after codes aims at creating an avenue through which nurse can share the experiences concerning the occurrence of code events. This sharing will entail the various terminal care services offered until the time of death. The platform will also provide an opportunity where various practices will be corrected in the case where mistakes arose in the process of providing care before the death of the patient. Good practices would also be commended for motivation purposes.
The proposal also aims to create a relationship between the debriefing after codes and grieving to both the nurses and the significant others to the patient. In the case of code event especially with patients who have been nursed for a good period, both the nurses and the relatives undergo grief. Through the implementation of debriefing after codes, the nurses and the relatives enjoy the opportunity of bidding farewell to the patient hence promoting healing and enhancing the grieving process to resolve efficiently.
PICOT
Among the nurses in the gynecology cancer hospital unit, how does implementing debriefing after codes enhance the care of patients and improve the needs of nurses when compared to other nurses in others units within the hospital where debriefings after codes are not carried within six months.
Literature search strategy employed
In search of the literature, various articles relating to debriefing after codes were evaluated. These included articles published within the last five years and underwent peer review. Despite the majority of the articles being the analysis of other articles that were done concerning the implementation of debriefing after codes. The search for literature also encompassed traversing various databases with scholarly articles pertaining nursing. These included Google Scholar, Pub Med and Cumulative Index of Nursing and Allied Health (CIHAHL).
Evaluation of the literature
Various articles provided literature that was relevant to the research topic. All the sources used were current and related to debriefing after codes. A study by Copeland, D., & Liska, H. (2016) on the implementation of post-code pose provided a concrete aspect of implementing the process in the unit. Despite the fact that they had the debriefing process that was aimed at meeting spiritual needs of various parties, facilitating recognition, acknowledgment as well as responding to the psychological needs of care providers within the emergency department, they saw it essential to introduce a post code pause process that would standardize the program. This aspect gives this article strength as this is unique can be applied to other centers of care like the gynecological cancer unit. On the other hand, the article didn’t provide the impact that the pause impact on the pausing to the staff members.
An article by Runnacles et al.,(2014) also provided an essential aspect of the implementation process. In their study, they brought the aspect of a need of a standard tool that ought to guide debriefing after codes. This identifies tool would be unit based have served the needs of the staff members that use it in their debriefing process. In spite of the significant determination, their articles only came up with the pediatric Objective Structured Assessment of Debriefing (OSAD) tool which applied to the pediatric intensive care unit. This made their contribution confined and not applicable for others settings without modification.
Sandhu et al., (2016) also provided an essential aspect of implementation that entails daily debriefing which does not necessarily follow code events. They pointed out that the daily debriefing provides for a constant platform that the staff members can air their concerns and share about the daily events. In the long haul, the members get to overcome burn out and the general worn-out and stress from the daily activities of care.
Applicable change or nursing theory utilized
This proposal utilized the Lewin’s theory of change which has three stages. These include unfreezing, change and refreezing. Unfreezing entailed the process of enabling the staff members within the unit let go the old system which has failed to meet their needs (Hayes, 2014). At this stage, the change agent overcomes the resistance from groups and individuals within the target team. In this case, the stage entails convincing the staff members of the impact of failure to debrief for instance increased instances of errors, burnout, and stress among nurses as well as impaired grieve process among the significant others.
The change stage involves the process that marks change, and this can be in the form of behavior, strategy, feeling, thoughts and implementation of the laid plan. The process leads to the liberation of a more productive encounter. In implementing debriefing after codes, the change stage will be marked by a change of behaviors and execution of laid down plans that will be conducted after all code events.
The refreezing stage is geared towards establishing the developed change as the new way of doing things within the setting. By doing so, it turns out to be the standard procedure that is maintained by all the concerned parties (Hayes, 2014). At this stage, the implementation of the proposal entailed the continuous assessment of the use of debriefing after codes and addressing any emerging issues. Guiding tools for the process are also distributed to see the process executed at all code events.
Proposed implementation plan with outcome measures
The plan entails setting the stage by creating an environment that supports learning from the code event and training facilitators that spearhead the entire process. The implementation takes the form of the team that has had a code event comes together having notified the facilitator to share their experience and corrects any mistakes if any occurred. In the process, everyone is given an opportunity to share their though with no blame or condemnation.
By facilitating the process, the staffs get less exhausted or stressed by the code events that occur in the process of care provision. At the same time, the nurses within the units get to bid farewell to their patient and promoting them to resume their usual duty without feeling guilty or responsible for the code event. This promotes the quality of their services in subsequent care provision.
Identification of potential barriers to plan implementation, and a discussion of how these could be overcome
Implementing debriefing after codes is likely to experience resistance from the staff members which can be in the form of an individual or group. This barrier is related to the consideration of the planned change being a foreign issue that originated from elsewhere. It is critical to handle this by engaging the entire member before introducing the change to the entire staff. This move will make the individuals own the proposal and advocate for its adoption.
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