Debriefing After Codes.
Debriefing after codes refers to the creation of a platform that staff expresses their experiences after significant events such as after a difficult resuscitation or even a mass causality incident. Hospitals can have regular debriefings to discuss various practices or relieve their staffs of stress while others might only do it in the case a unique thing happens to warrant the session. The idea originated from the military where the soldiers held discussions after a war. The purpose is similar to what exists in the clinical area. Debriefing after codes has various aspects attached to it ranging from the following guidelines in the process of debriefing, simulation training about the process, the processes involved in carrying out a debriefing as well as the intended purpose for the debriefing. All these are critical to the understanding of the entire concept of debriefing after codes. This article provides a word review of various articles that dwelt on debriefing after codes.
Comparison of research questions
The research questions from the articles were directed at various issues based on the purpose of the study since their answers were to provide essential information in achieving the objectives of the entire study. In their study, Blankenship et al., (2016) were up to know the ability of multidisciplinary code review committee in determining deficiencies and lead to educational initiatives. A related type of committee is also used to pose the question of the impact of the daily multidisciplinary debriefings (Sandhu et al., 2016). These assertions are relatively deferent from the question in the study by Runnacles et al. which was aiming at the determination of the features of a standard debriefing process that would precede tool development to guide the process in various settings.
Sjöberg, Schönning, and Salzmann‐Erikson, (2015) on the other hand posed their questions enquiring on the experiences that the nursing team had had towards the debriefing process which they claim ought not to be directed on the determination of errors but to improve the quality of care. The focus on quality is also evident in the questions posed by Wolfe et al. which needed information on the impact of the debriefing process on the CPR quality (2014).
Comparison of sample populations
Firing, K., Johansen, L. T., & Moen, F. (2015) conducted their study on a rescue crew that took part in debriefing and the result of the process determined. The study population was however small for generalization of the outcome. Nerovich et al. had a diverse sample population that included chaplain within the pediatric care center, staff nurses and nurse managers. Also, these groups were restricted only to have those with 55 years of experience. In the determination of the features of ideal debriefing process, Runnacles et al. used a sample population constituting of 16 pediatricians, facilitators, and learners (2014). Santhu et al. (2016) used a sample based on the ICU constituting of 42 nurses, two nurses managers, one pharmacist, one nutritionist and one social worker. Similarly, Wolfe et al., (2014) had their sample population in the ICU that constituted patient undergoing the chest compressions during cardiac arrest management.
Comparison of the limitations of the study
On their study concerning the holistic approach of debriefing, Firing, Johansen, & Moen, (2015) had a small sample population that only constituted of the rescue crew who experience an extreme situation. This makes the findings not be able to be generalized to other populations or even other situations. Kassutto et al. (2016), analyzed the recording methods that are geared towards facilitating debriefing after codes. Despite the determination of the recording gap between the video and audio recording during code events, they determined that distractions during the processes may make their contribution cumbersome to apply in a real healthcare setting.
Besides, Runnacles et al. (2014) determined 307 features of a debriefing process that lead to the development of Objective Structured Assessment of Debriefing (OSAD) tool which had eight dimensions. Due to the setting of this study which made it based on pediatric debriefing, the tool is only limited to pediatric care centers. Its utilization in other units, therefore, requires modification to improve the care of patients. Similar to this case, the study by Sandhu et al. (2016), also determined daily informal multidisciplinary operational debriefing to benefit the nurses in reducing the burnout and the stress, yet the model cannot be generalized in other settings. This limitation leads to the modification of the model for it to fit in other unrelated units.
Conclusion
The studies indicate various aspects of debriefing after codes with a common purpose in the healthcare setting. A multidisciplinary code-review committee has the potential if determining the potential deficiencies that can lead to improvement of care and educational initiatives. According to Blankenship et al.,(2016) the entire institution can benefit from this committee if coupled with a hospital-wide debriefing process. Debriefing after codes can also benefit from video recording that provides a high-quality source of material for review. This can promote structured debriefing after codes. There is need to research on ways of preventing distractions during the recording period that makes the process less objective.
Tools that guide debriefing such as OSAD tool gives room for a structured approach to debriefing. Although the tool may not be generalized, it is essential to venture in researching ways of coming up with a universal tool that will fit all care settings in the hospital.
References:
Blankenship, A. C., Fernandez, R. P., Joy, B. F., Miller, J. C., Naguib, A., Cassidy, S. C., … &
Yates, A. R. (2016). Multidisciplinary Review of Code Events in a Heart Center.
American Journal of Critical Care, 25(4), e90-e97.
Firing, K., Johansen, L. T., & Moen, F. (2015). Debriefing a rescue mission during a terror
attack. Leadership & Organization Development Journal, 36(6), 778-789.
Kassutto, S. M., Kayser, J. B., Kerlin, M. P., Lipschik, G., Upton, M., &Schweickert, W. D.
(2016). Analysis Of Recording Methods To Facilitate Debriefing After Cardiac Arrest
Resuscitation. In B35. INNOVATIONS IN MEDICAL EDUCATION (pp. A3208-
A3208). American Thoracic Society.
Nerovich, C., Thime, K., Manzardo, J., &Derrington, S. (2016). 1267: DESIGNING AND
IMPLEMENTING A DEBRIEFING TOOL TO REDUCE COMPASSION FATIGUE
AND BURNOUT IN THE PICU. Critical Care Medicine, 44(12), 392.
Runnacles, J., Thomas, L., Sevdalis, N., Kneebone, R., & Arora, S. (2014). Development of a
tool to improve performance debriefing and learning: the paediatric Objective Structured
Assessment of Debriefing (OSAD) tool. Postgraduate medical journal, 90(1069), 613-
621.
Sandhu, G., Colon, J., Barlow, D., & Ferris, D. (2016). Daily Informal Multidisciplinary
Intensive Care Unit Operational Debriefing Provides Effective Support for Intensive Care
Unit Nurses. Dimensions of Critical Care Nursing, 35(4), 175-180.
Sjöberg, F., Schönning, E., & Salzmann‐Erikson, M. (2015). Nurses’ experiences of performing
cardiopulmonary resuscitation in intensive care units: a qualitative study. Journal of
clinical nursing, 24(17-18), 2522-2528.
Wolfe, H., Zebuhr, C., Topjian, A. A., Nishisaki, A., Niles, D. E., Meaney, P. A., … &Apkon,
- (2014). Interdisciplinary ICU cardiac arrest debriefing improves survival outcomes.
Critical care medicine, 42(7), 1688.
