Ethicists Hold Debriefings After Critical Patient Events
August 1, 2023 2 minutes read
As a new nursing graduate working in a pediatric ICU, Courtney Nerovich, BSN, RN, struggled emotionally after experiencing an unsuccessful code for the first time. “I wasn’t sure I would be able to handle the stress, anxiety, and trauma this job entailed,” Nerovich recalls.
Once Nerovich became the charge nurse in the PICU at Ann & Robert H. Lurie Children’s Hospital of Chicago, those feelings only intensified. After another unsuccessful resuscitation, an attending physician noticed Nerovich’s emotional distress and pulled her aside to discuss the case. “He gave me the time to ask questions, vent, and decompress. I remembered how much better I felt after talking through the event with a colleague,” Nerovich says.
As chair of the hospital’s bereavement and wellness committee, Nerovich was determined to find ways to support clinical teams after traumatic events. “I knew the staff was desperate for support surrounding these types of events,” Nerovich says.
Ethicists did offer debriefings to staff after difficult cases. However, the debriefings usually happened days or weeks after the event and were poorly attended. Nerovich, an attending physician, a PICU chaplain, and a nurse manager, developed a Rapid Review of Resuscitation debriefing process with a one-page guide.1
The process is simple: Ethicists review the event and the team dynamics, acknowledge the emotional impact of the case, and take a moment of reverence in cases where the patient died. “Many people were willing and open to these debriefings, which gained momentum throughout the hospital,” Nerovich shares.
Other clinical areas heard about the debriefings and asked to be included. The committee members trained those units on how to lead the debriefings and made the tool available hospitalwide. “The culture shifted from ‘Suck it up and move on’ or ‘Just learn how to deal with it or find another department’ to finding ways to best support one another,” Nerovich says.
Nerovich and colleagues surveyed 222 ICU staff before and after the new debriefing process was implemented. Compassion satisfaction scores were significantly higher one year later. Most (74%) staff found the debriefing “somewhat” or “very” helpful.
In the emotionally charged, fast-paced ICU, clinicians are faced with death and dying daily.
“Staff will regularly face ethical dilemmas and challenges,” Nerovich says. “Having open, honest communication about these situations will help build a moral and ethical community.”
REFERENCE
1. Nerovich C, Derrington SF, Sorce LR, et al. Debriefing after critical events is feasible and associated with increased compassion satisfaction in the pediatric intensive care unit. Crit Care Nurse 2023;43:19-27.
In the emotionally charged, fast-paced ICU, clinicians are faced with death and dying daily. Engaging in open, honest communication about these situations will help build a moral and ethical community.
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