Debriefing After Codes Capstone
Nursing care entails the availability of a nurse to provide care that is of quality and safety. Through patient-centered nursing care, the nurse assesses and identifies the needs of each patient and assists the patient in meeting them with significant concentration to the beliefs and values of the patient. The process of carrying all the above activities in nursing practice, various process are encountered. Instances of medical errors, code events and even the successful outcomes from the care provision among others come about. Whether good or bad, the debriefing turns to be an issue in many of the clinical setups as there exist minimal structural frameworks to guide such a practice (Sandhu et al., 2016).
Debriefing, especially after code events, provides a platform where the nursing staffs can share their experiences aiming at improving the practice in future in the case such events are encountered. Debriefing supports the evidenced-based practice in that the practices that were undertaken during an event can be shared as well as the skills for a best practice to be embraced in other setups. The discussion about the practices among the staff members allows togetherness among the staffs and also impacts the patient care significantly since best practices will allow the raising of the quality of care and improve the patients’ survival levels. The research will revolve around the significance of debriefing after codes in various setting to the nursing staff and the care of patients.
PICOT statement.
Among the nurses in the inpatient units, how do code debriefing enhance the patient care and improve the nurses’ needs when compared to other nurses in other units where debriefings after codes are not done in the case such event happens in the future?
Reference list.
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.
This study aimed at determining the cause of clinical deterioration, examining resuscitation efforts and correcting system issues by the use of a multidisciplinary code reviewing process following code events. It did this via retrospective analysis following code events in a pediatric heart center.
47 code events were reviewed by a multidisciplinary team with 16 considered preventable. About two issues were identified and reviewed in the process of cardiopulmonary arrest. Critical issues determined revolved around communication, patient care, equipment and environment. 60 % of the reviews led to educational initiatives such as mock codes and simulation debriefings while 47% led to change of policy. Survival to discharge within the unit improved for some time to the level of 81%.
The study recognizes the significance of the debriefing after codes because it is essential in the determination of deficiencies hence leading corrective initiatives such as educational initiatives and improvement of care. When this is applied to other sectors within the hospital, it can impact all the sectors regarding quality care being provided.
Firing, K., Johansen, L. T., & Moen, F. (2015). Debriefing a rescue mission during a terror
attack. Leadership & Organization Development Journal, 36(6), 778-789.
This article aims at exploring the understanding of the holistic debriefing process from the learning approach. It used a case study where there was a terror attack leaving 69 people dead and 66 others maimed. The crew that went to rescue them endured the impact of the disaster but experience fearful feelings towards death as they were assisting the victims of the incident. It is after this scenario that the crew participated in a holistic debriefing after which interviews were done to share their experiences of the type of debriefing.
The holistic debriefing session’s results indicated a positive experience that was supportive i9n regards to emotions, meaning and the social support. Despite that the study was conducted among a small group of people and may not be generalized, it turned out to be an indicator of the importance of debriefing process. It is such significance that has pushed most of the governmental forces departments to employ the strategy to their teams to relieve them from the traumatic experiences that they undergo from their fields of practice.
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.
The descriptive study aimed at measuring the burnout and compassionate fatigue in the pediatric intensive care unit and come up with a debriefing tool that would assist in reducing their impact on the unit’s staff. A survey was sent to PICU staff asking them open-ended questions concerning the effect the codes and deaths were placing on them as well as a ProQOL measure was administered to measure the compassion satisfaction, burn out and fatigue. A debriefing process was then organized to meet the staff needs, reviewing the clinical events, honouring the lives of the children who succumbed as well as acknowledging the impact the code events had on the staff.
104 out of the 222 PICU staff completed the survey. The ProQOL and the scores for fatigue, burnout and stress were high in many participants. After the implementation of the debriefing processes and over a period of 9 months, 33 deaths occurred, 21 debriefings were conducted. The feedback indicated a positive response with the staff appreciating the process with the feeling of being less worn out and less overwhelmed after occurrences of code events.
According to the study, the pediatric intensive care unit staff encounters intense stress from traumatic events, inadequate satisfaction as well as burnout. The implementation and use of debriefing that dwells on both the medical issues as well as the emotional issues following a code event to honour the life of the child and the needs of the staff are possible. It is through processing of the code events by staff that will see them relieved of the stress, burnout and feel more satisfied with the care they provide.
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.
In improving the clinical performance by use of the debriefing after codes, there is a need for simulation to allow training and learning to make the practice a reality. This study was conducted to develop a tool that would guide and assess the debriefing after simulations of code events in pediatric unit with the application of evidence-based practice and research. It used literature review and semi-structured interviews for the identification of features pertaining to the pediatric simulation debriefing. Theme analysis was then used to determine the critical components of an effective debriefing to act as the tool for assessing the effectiveness of debriefing.
34 relevant studies were identified, 16 paediatricians interviewed together with the debriefing facilitators and learners. 307 features of debriefing were determined and grouped into eight dimensions representing the vital components of a pediatric debriefing. The eight dimensions were used to create a tool—Objective Structured Assessment of Debriefing. It had a Likert scale that had descriptions for scoring the process. The tools provide a structured approach to pediatric simulation debriefing and are based on published literature and information from both learners and facilitators. It can be used as a guide on improving the quality of debriefing after pediatric simulation.
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.
The purpose of conducting this descriptive study was to obtain the perception of the attendees on the implementation of the daily operational debriefings. This was done in regards to the fact that most organizations already have programs that cater for management of stress among their workers. The authors recognized the need for these approaches to be modified to be able to meet the need for individual units that fits them appropriately. It developed a process of daily debriefing that used the concepts of the traditional debriefings but was now offered on a regular basis as opposed to the usual one that is only conducted after an occurrence of a code event. The debriefings were supposed to be informal, brief and compose of a multidisciplinary team.
After six months of the use of the process, the attendees were subjected to an anonymous voluntary survey. Out of the 47 respondents, 42 completed the survey. A supermajority had a feeling that the daily debriefings were useful in providing a unit based support system, togetherness and concern for others. 50% of them reported a reduced level of stress with 98% advocating for the continuation of the program. This led to the conclusion that the daily informal debriefing in the ICU was vital in providing a support system to the ICU staff and this could be extended to other units by modifying the model to fit them.
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.
This study targeted to evaluate the efficiency of an interdisciplinary post-event quantitative debriefing program to improve the care outcome in pediatric resuscitation event. A structured, quantitative, audiovisual and multidisciplinary debriefing was done for chest compression events with the in-front providers of such care. The basic outcome of this study was survival until hospital discharge with the secondary outcome being survival for the event and better neurological outcome.
There was 119 chest compression events. On analyzing the data, the interventions led to a trend indicating improved survival rate to hospital discharge. There was also a significant increase in survival with the neurological functions remaining favorable. In the event of cardiopulmonary resuscitation to an eight years old or older patient during the debriefing period, the patient was 5.6 times more probable to meet the set level of excellence in cardiopulmonary resuscitation. It is from these findings that the study concluded on the relationship between implementation of an interdisciplinary debriefing program with improved cardiopulmonary resuscitation quality as well as survival with better results on neurological function.
