Search

Introduction: Traditional simulation debriefing is both time‐ and resource‐intensive. Shifting the degree of primary learning responsibility from the faculty to the learner through self‐guided learning has received greater attention as a means of reducing this resource intensity. The aim of the study was to determine if video‐assisted self‐debriefing, as a form of self‐guided learning, would have equivalent learning outcomes compared to standard debriefing. Methods: This randomized cohort study consisting of 49 PGY‐1 to ‐3 emergency medicine residents compared performance after video self‐assessment utilizing an observer checklist versus standard debriefing for simulated emergency department procedural sedation (EDPS). The primary outcome measure was performance on the second EDPS scenario. Results: Independent‐samples t‐test found that both control (standard debrief) and intervention (video self‐assessment) groups demonstrated significantly increased scores on Scenario 2 (standard—t(40) = 2.20, p < 0.05; video—t(45) = 3.88, p < 0.05). There was a large and significant positive correlation between faculty and resident self‐evaluation (r = 0.70, p < 0.05). There was no significant difference between faculty and residents self‐assessment mean scores (t(24) = 1.90, p = 0.07). Conclusions: Residents receiving feedback on their performance via video‐assisted self‐debriefing improved their performance in simulated EDPS to the same degree as with standard faculty debriefing. Video‐assisted self‐debriefing is a promising avenue for leveraging the benefits of simulation‐based training with reduced resource requirements. [ABSTRACT FROM AUTHOR]

Introduction: Between 9 and 44% of women experience giving birth as traumatic, and 3% of women develop a post-traumatic stress disorder following childbirth. Knowledge on risk factors is abundant, but studies on treatment are limited. This study aimed to present an overview of means to prevent traumatic birth experiences and childbirth-related post-traumatic stress disorder.Material and Methods: Major databases [Cochrane; Embase; PsycINFO; PubMed (Medline)] were searched using combinations of the key words and their synonyms.Results: After screening titles and abstracts and reading 135 full-text articles, 13 studies were included. All evaluated secondary prevention, and none primary prevention. Interventions included debriefing, structured psychological interventions, expressive writing interventions, encouraging skin-to-skin contact with healthy newborns immediately postpartum and holding or seeing the newborn after stillbirth. The large heterogeneity of study characteristics precluded pooling of data. The writing interventions to express feelings appeared to be effective in prevention. A psychological intervention including elements of exposure and psycho-education seemed to lead to fewer post-traumatic stress disorder symptoms in women who delivered via emergency cesarean section.Conclusions: No research has been done on primary prevention of traumatic childbirth. Research on secondary prevention of traumatic childbirth and post-traumatic stress disorder following delivery provides insufficient evidence that the described interventions are effective in unselected groups of women. In certain subgroups, results are inhomogeneous. [ABSTRACT FROM AUTHOR]

Background: Approximately 5%-10% of newly born babies need intervention to assist transition from intra- to extrauterine life. All providers in the delivery ward are trained in neonatal resuscitation, but without clinical experience or exposure, training competency is transient with a decline in skills within a few months. The aim of this study was to evaluate whether neonatal resuscitations skills and team performance would improve after implementation of video-assisted, performance-focused debriefings.Methods: We installed motion-activated video cameras in every resuscitation bay capturing consecutive compromised neonates. The videos were used in debriefings led by two experienced facilitators, focusing on guideline adherence and non-technical skills. A modification of Neonatal Resuscitation Performance Evaluation (NRPE) was used to score team performance and procedural skills during a 7 month study period (2.5, 2.5 and 2 months pre-, peri- and post-implementation) (median score with 95% confidence interval).Results: We compared 74 resuscitation events pre-implementation to 45 events post-implementation. NRPE-score improved from 77% (75, 81) to 89% (86, 93), P < 0.001. Specifically, the sub-categories "group function/communication", "preparation and initial steps", and "positive pressure ventilation" improved (P < 0.005). Adequate positive pressure ventilation improved from 43% to 64% (P = 0.03), and pauses during initial ventilation decreased from 20% to 0% (P = 0.02). Proportion of infants with heart rate > 100 bpm at 2 min improved from 71% pre- vs. 82% (P = 0.22) post-implementation.Conclusion: Implementation of video-assisted, performance-focused debriefings improved adherence to best practice guidelines for neonatal resuscitation skill and team performance. [ABSTRACT FROM AUTHOR]

Introduction: The psychomotor skill of cardiopulmonary resuscitation emphasized the importance of high-quality chest compression. This investigation examined the effect of self-debriefing and the different materials of debriefing during hands-on cardiopulmonary resuscitation practice for healthcare providers. Methods: This was a randomized controlled trial of a cardiopulmonary resuscitation training program involving emergency medical technicians in northern Taiwan. Participants were blinded to the study purpose and were allocated randomly using the black envelope method. All participants completed a 2-min pre-test of hands-only cardiopulmonary resuscitation using a manikin. Those who were allocated to the control group received self-debriefing with knowledge of pre-test result. Those who were allocated to the experimental group received self-debriefing with an additional biomechanical information of performance of chest compression. A post-test was performed 30 min after the pre-test. Results: A total of 88 participants were enrolled with 44 in each group. There was significant difference of cardiopulmonary resuscitation quality after self-debriefing among all participants (pre- vs post-test adequate rate, 54.7% vs 67.5%, p = 0.028; adequate depth, 41.2% vs 69.5%, p < 0.001; full recoil, 35.9% vs 54.5%, p = 0.001). The analysis of effects of self-debriefing with additional knowledge of performance revealed no significant difference in any of the measurements (improvement in adequate rate, 11.3% vs 14.2%, p = 0.767; adequate depth, 29.6% vs 27.0%, p = 0.784; full recoil, 23.0% vs 14.1%, p = 0.275). Conclusion: Self-debriefing improved hands-only cardiopulmonary resuscitation quality whether or not biomechanical information of performance of chest compression was given. [ABSTRACT FROM AUTHOR]

Background There are few studies in occupational therapy that compare the perceptions of supervisors and students regarding quality clinical placement programmes, and those that exist indicate substantial differences in the perceptions held by each group. Methods This pilot study was conducted using a cross-sectional descriptive design, with a single questionnaire distributed to occupational therapy students and clinical supervisors. A total of 40 questionnaires were returned: 17 from students and 23 from clinical supervisors. Results Differences were found between the perceptions of occupational therapy students and clinical supervisors in response to four topics: preparation from the university for their placements; consistency across placement sites; instances of supervisors seeking feedback from students; and the burden associated with the placement-related workload for clinicians. Discussion Different perceptions around preparation from universities and consistency across placement sites relate to the existing roles of each group: students are more aware of university preparation and clinical supervisors are more aware of organisational inconsistencies in their respective usual work environments. The discrepancy in the perceived seeking of feedback from students has also been reported in student debriefing sessions. The burdens perceived by clinical supervisors appear to be influenced by a belief that clinical education is an additional duty rather than a core role. [ABSTRACT FROM AUTHOR]

Background: Structured debriefing is an essential part of effective learning from simulation. The advocacy-inquiry method (AIM) is a newer debriefing model where the facilitator seeks to understand the student ' s underlying rationale for their decisions. Methods: We surveyed two cohorts of 21 fi nal- year medical students who had experienced AIM debriefing during a simulation programme across two semesters. Data were collected on students' prior experience of debriefing, their perceptions of being involved in AIM, and which aspects of the curriculum they felt AIM addressed best. Results: The age ranged from 22 to 31 years; 74 per cent (n = 31) were female. Fifty- seven per cent (n = 24) of the group had prior experience of simulation and 88 per cent of these (n = 21) had experienced dedicated debriefing time, mainly using Pendleton ' s guidelines. Ninety- one per cent (n = 38) of the students felt that the area covered best using AIM was clinical assessment. Seventyone per cent of students (n = 30) felt that they were encouraged to 'explore and challenge [their] underlying thoughts, attitudes and beliefs' during the debriefing. Only two students (5%) agreed with the statement that they felt uncomfortable during the debriefing exercise. Students in the second semester were less likely to want the lead clinician to 'just tell me what to do' (p = 0.009). Discussion: Our fi ndings demonstrate that students perceive AIM as an acceptable method of debriefing. We suggest that the second cohort ' s attitudes towards being 'told what to do' are the result of maturing learning styles throughout their fi nal year. The direct questioning involved is acceptable to the majority of students and we encourage the use of AIM debriefing in an undergraduate setting. [ABSTRACT FROM AUTHOR]

The objective of this study was to discover potential ways to enhance debriefing so that more can be learned from the experience of extreme events. In order to reach this aim, we explored how personnel in the Explosive Ordnance Disposal team from the Norwegian Armed Forces experienced debriefing after an extreme event. That event was a terror attack on the Norwegian island of Utøya on 22 July, 2011, in which 69 people were killed and 66 were wounded. An Explosive Ordnance Disposal team was sent to the island to search for and disarm potential bombs. We explored how personnel in the team experienced their debriefing after this event. Reports of interviewees' experiences identified two relevant dimensions: content (technical and personal) and form (formal and informal), leading to the development of four categories. The main learning points were that although personnel experienced room to share technical issues during debriefing and hence learn from the situation, there were fewer opportunities to share personal issues, and this seemed to limit the debriefing as a learning process. [ABSTRACT FROM AUTHOR]

This paper explores how Holistic Debrief, a new concept in the field of debriefing and reflective processes, can contribute to restitution, reflection and learning in professional teams following stressful events and routine tasks. Interviews were conducted with Norwegian military aircrew mission commanders following deployment to Afghanistan in 2010. Phenomenological analysis in the frame of social learning theory revealed that reflective processes were easier to facilitate after stressful events than after routine tasks. Challenges identified included lack of trust during the early stages of team establishment and poor conceptual repertoires among aircrew commanders undertaking facilitation. Relational trust and reflective processes tended to improve after stressful events. Repeated interactions in Holistic Debrief tend to increase familiarity, trust and learning potential over time. This study reports data from the war context, an environment not often available for qualitative research. The findings are relevant for military and other operational units who wish to develop their debriefing practice and create an experience-based learning environment. [ABSTRACT FROM AUTHOR]

Persuasion is undoubtedly a critical negotiation skill. But while the literature has examined its role in negotiation, few, if any, scholars or practitioners have offered a clear strategic framework for putting persuasion into negotiation practice. The ethos, pathos, and logos modes of persuasion elucidated by Aristotle in the fourth century B. C.E. provide a clear, understandable, and easy-to-apply framework that students and trainees can use to prepare for negotiation, to deploy during the negotiation process, and to conduct debriefings following a negotiation. In this article, I describe how to apply this Aristotelian framework and explain an additional dimension of persuasion in negotiation that I believe is also critical: timing. Through the real-world example of Anwar Sadat and his trip to Jerusalem, I demonstrate how this framework has worked in practice. [ABSTRACT FROM AUTHOR]

The article offers the author's insights regarding the benefits offered by briefing and debriefing in the practice of surgeons. The author mentions several studies that shows various benefits of briefing and debriefing which include effective surfacing of potential surgical safety hazards, reduction of risk among perception of staffs, and improves patient safety and staff perception of teamwork.

Background Teaching communication skills using role-play addresses an important learning need for medical students, with the debriefing process being central to the learning that occurs. In this work we examine the feasibility of using actor-reported 'anger scores', during a challenging communication scenario, as a tool to stimulate debriefing. Methods This teaching session was delivered to 10 groups of final-year MBBS (Bachelor of Medicine and Bachelor of Surgery) students at Newcastle University. One student from each group took on the role of the foundation year 1 (F1) doctor and had 10 minutes to talk to an angry relative (actor), who was unhappy with the care her mother had received. During the scenario the actor recorded her level of anger on a 10-point Likert scale (1, 'no anger'; 10, 'extreme anger') at 1-minute intervals. Once the scenario was complete, the in-room tutor graphically presented these scores against time. During debriefing, students were asked to examine the graph produced: fluctuations in anger levels were identified, discussion was held regarding possible precipitants for the changes seen and strategies were developed for tackling future such incidents. Results Examples of graphs produced during the session are presented, including annotations highlighting the discussion topics that arose. Feedback on the session from both students and actor was positive, with no reports that the scoring process interfered with the fidelity of the scenario. Discussion We believe that actor-reported 'anger scores' provide a quick, simple and cheap method of producing a visual aid to the debriefing process that, in the context of a challenging communication scenario, provided a stimulus for discussion. [ABSTRACT FROM AUTHOR]

Negotiation teachers have many goals. Improving a student's skills of observation, analysis, and diagnosis, and building his or her capacity to translate theory to practice are often among the most important of these. The Critical Decisions in Negotiation video project seeks to advance these goals. The video features four sets of professionals negotiating a simulation, and then debriefing key parts of the negotiation afterward with Professor Robert Bordone to reveal the thought processes that motivated particular behavioral moves. Bordone provides commentary after each sequence to connect theory to practice. The video project is organized around three broad themes - openings and process, dealing with difficult tactics, and active listening and effective assertion. Key features include a detailed teaching note, unscripted professionals in action, and unvarnished reviews by the negotiators themselves after the fact. The method employed by the Critical Decisions in Negotiation video represents a valuable new pedagogical tool for negotiation instructors and students alike. [ABSTRACT FROM AUTHOR]

Psychological debriefing was developed in the 1980s as an approach for use with people whose work exposes them to stressful incidents. It aims to help them to process the thoughts and emotions arising from their work. Subsequently, several randomized controlled trials tested truncated forms of debriefing in a different population: primary victims of unexpected trauma. These trials, and particularly two in which debriefing appeared to be harmful, led two major reviews to warn practitioners not to offer debriefing. Consequently, many organizations have stopped providing debriefing to employees who face trauma in their routine work. This paper argues that there are at least three reasons for the apparent failure of 'debriefing' in the two studies that reported adverse effects. First, the 'debriefing' did not follow protocol in terms of timing, length, and training and independence of the debriefer. Second, the patients who were 'debriefed' reported more severe initial symptoms than those who were not. Third, 'debriefing' was used with individuals for whom it was not originally intended. Psychological debriefing is intended to be used with groups of people who have been briefed together before going on to work together in stressful situations. Such groups have reported that they find psychological debriefing helpful, and research is emerging indicating that appropriate debriefing may indeed benefit these groups. We call for reviewers to recognize the limitations of debriefing research and not to overgeneralize their conclusions. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: • Warnings about the dangers of psychological debriefing are based on studies using an intervention that is very different from that used for disaster workers and military personnel. • Evidence relating to primary victims of trauma has been overgeneralized to secondary victims. • Psychological debriefing may harm if it is too short, too probing, conducted too soon or delivered by debriefers with insufficient training or experience. • Research is urgently needed on appropriate debriefing for occupational groups briefed to work in stressful situations. [ABSTRACT FROM AUTHOR]

Aliment Pharmacol Ther 2010; 32: 591–602 Background Current questionnaires for assessing gastro-oesophageal reflux disease (GERD) symptoms are limited in their ability to capture nocturnal symptoms. Aim To develop and validate an instrument, the Nocturnal Gastro-oesophageal Reflux Disease Symptom Severity and Impact Questionnaire (N-GSSIQ), to assess severity and impact of nocturnal GERD symptoms. Methods Two focus groups and 16 cognitive debriefing interviews were conducted among GERD patients to identify key issues about nocturnal symptoms. A draft instrument was tested in 196 patients at 11 clinics in the US to evaluate psychometric properties. Exploratory factor and item response theory analyses were conducted to finalize items and subscales. Internal consistency reliability, reproducibility and construct validity were examined. Results Mean age was 45 (s.d. = 13.8) years; 76% were female and 68% were Caucasian. Patient-rated severity was mild–moderate for 69% of participants; 48% reported symptoms on two to three nights the past week. The final questionnaire includes 20 items and three subscales: Nocturnal GERD Symptoms, Morning Impact of Nocturnal GERD and Concern about Nocturnal GERD. The subscales demonstrated internal consistency reliability (Cronbach’s alpha 0.84–0.94) and were significantly correlated with similar measures and disease severity (0.41–0.81; P < 0.0001). Conclusion The results support the reliability and validity of the N-GSSIQ as a measure of severity, morning impact and concern about nocturnal GERD. [ABSTRACT FROM AUTHOR]

Anecdotally critical incident debriefing (CID) is an important topic for staff in paediatric ED. The present study aimed to determine current baseline CID practices and perceived needs of ED staff. A questionnaire regarding CID practice was circulated to all 13 Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites in Australia and New Zealand (including all tertiary paediatric ED), and completed by 1 senior doctor and 1 senior nurse. All PREDICT sites participated (13 nurses, 13 doctors). Seventy per cent did not currently have a hospital protocol on debriefing and 90% did not have ED-specific guidelines. The most commonly debriefed topics were death of a patient, multi-trauma and sudden infant death syndrome, also ranked highest in importance for debriefing. The median reported debriefs per department were 4 per year (range 0–12), all conducted within a week of the CI with half within 24 h. ED workers most likely to be invited to the CID session were doctors, nurses and social workers (96%). Debriefing was mostly conducted internally (62%) and most likely facilitated by a doctor (81%) or nurse (54%). Debriefing addressed both clinical and emotional issues (89%) within the same session (69%). Debriefing was rated as very important, median of 8/10 by doctors and 10/10 by nurses. Almost 90% of those surveyed indicated that they would like a CID programme and guidelines for their department. Debriefing is perceived as important by senior ED clinicians, yet few ED have formalized guidelines or programmes. Best-practice guidelines should be developed. [ABSTRACT FROM AUTHOR]

Controversy over the use of Critical Incident Stress Debriefing leaves Emergency Medical Services (EMS) organizations with little direction in preventing sequelae of Critical Incident Stress (CIS) in their employees. Objectives of the study were to explore and describe Emergency Medical Technicians' (EMTs) experiences of critical incidents and views about potential interventions, in order to facilitate development of interventions that take into account EMS culture. We interviewed 60 EMT practitioners and supervisors, and examined interview transcripts using ethnographic content analysis. EMT practitioners want emotional support in their workplace soon after a critical incident, and welcome interventions that would enhance this. They also experience a brief timeout as important in preventing sequelae of CIS. Exchanges with supervisors and peers that are experienced as supportive are illustrated. Barriers to support are described, as well as ways to address them. Educating supervisors and front-line practitioners to recognize and respond supportively to critical incidents is acceptable to them. However, an organizational culture that stigmatizes vulnerability is the most insidious and challenging barrier to accessing support after a critical incident. Addressing the issue of stigma is critical to developing appropriate interventions. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Approximately 16% of consumers are secluded during an inpatient admission. Despite the harmful psychological consequences resulting from the use of physical force, restraint, control, and temporary sequestration of therapeutic communication, there is little evidence of nursing practices to support consumers who are secluded. This paper will outline the findings from an action research project examining post-seclusion debriefing practice. A series of focus groups was undertaken with mental health nurses (MHN) and consumer consultants (CC) to investigate current practice, identify consumer/clinician preferences, and scope future practice possibilities. The findings suggest that CC need assistance in dealing with the negative feelings evoked by seclusion. MHN use a range of approaches for debriefing; however, these sometimes do not meet consumer preferences. MHN focus on explaining why seclusion happened and how to avoid it. While mitigation is a critical issue, CC want more emotional support from debriefing. MHN saw the possibility of using the debriefing to support consumers' transit from seclusion to high-dependency status and then to low-dependency status. Opinions raised regarding the potential for CC to have a role in debriefing were divided. The findings will be used to inform the development of a consumer debriefing training program for MHN and CC. [ABSTRACT FROM AUTHOR]

The authors present a four-step model of debriefing as formative assessment that blends evidence and theory from education research, the social and cognitive sciences, experience drawn from conducting over 3,000 debriefings, and teaching debriefing to approximately 1,000 clinicians worldwide. The steps are to: 1) note salient performance gaps related to predetermined objectives, 2) provide feedback describing the gap, 3) investigate the basis for the gap by exploring the frames and emotions contributing to the current performance level, and 4) help close the performance gap through discussion or targeted instruction about principles and skills relevant to performance. The authors propose that the model, designed for postsimulation debriefings, can also be applied to bedside teaching in the emergency department (ED) and other clinical settings. [ABSTRACT FROM AUTHOR]

In a group randomized trial of critical incident stress debriefing (CISD) with platoons of 952 peacekeepers, CISD was compared with a stress management class (SMC) and survey-only (SO) condition. Multilevel growth curve modeling found that CISD did not differentially hasten recovery compared to the other two conditions. For those soldiers reporting the highest degree of exposure to mission stressors, CISD was minimally associated with lower reports of posttraumatic stress and aggression (vs. SMC), higher perceived organizational support (vs. SO), and more alcohol problems than SMC and SO. Soldiers reported that they liked CISD more than the SMC, and CISD did not cause undue distress. [ABSTRACT FROM AUTHOR]

The present study examines whether the experience of a critical incident (CI) is associated with higher burnout scores; whether strong social support is associated with reduced burnout scores; and whether social support moderates the relationship between a CI and burnout scores. Security guards (n = 530) filled out the Maslach Burnout Inventory, the Self-Rating Inventory for Post-traumatic Stress Disorder and the Social Support List. The experience of a CI was reported by 41.1 per cent of the participants, which explained a significant amount of variance in the participants' burnout scores. Everyday emotional support and social companionship were negatively related to burnout. Emotional support with problems showed a positive association with burnout. The authors suggest that the first two forms of social support may function as buffers, whereas the latter could have an aggravating effect on burnout complaints. No significant interaction effects between social support and CI were present. This indicates that, in the present study, social support did not have a moderating effect on the relationship between a CI and burnout. Relations between social support and burnout are discussed, as are limitations of this study and suggestions for further research. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Critical incident experiences are a powerful source of counselor development (T. M. Skovholt & P. R. McCarthy, 1988a, 1988b) and are relevant to attachment issues. An attachment theory perspective of supervision is presented and applied to a critical incident case scenario. By focusing on the behavioral systems (i.e., attachment, caregiving, and exploratory) identified by J. Bowlby (1969), previous conceptualizations are expanded by illuminating relational concepts that supervisors could use to facilitate counselor learning. [ABSTRACT FROM AUTHOR]

In this study, 228 school psychologists completed a survey regarding crisis intervention teams and plans. The majority of respondents indicated their schools had crisis plans (95.1%) and teams (83.6%). The most common team activities endorsed by participants involved providing direct assistance and services to students, staff, and the media. The majority of participants (93%) reported that their schools had experienced and responded to serious crises. Respondents indicated that psychological debriefing was frequently used (generic 49.1% and standardized 17.9%). Less than half of the participants (44.3%) reported that meetings were conducted with parents and community members following a crisis. Nearly all of the participants (98.2%) reported that they had some type of crisis intervention training. However, many participants suggested that additional training and practice with crisis intervention would improve schools' crisis responses. Results are discussed with implications for school psychologists to improve their schools' crisis intervention plans and teams' responses. © 2007 Wiley Periodicals, Inc. Psychol Schs 44: 749–764, 2007. [ABSTRACT FROM AUTHOR]

The Critical Incident Stress Management (CISM) model for crisis intervention was developed for use with emergency service personnel. Research regarding the use of the CISM model has been conducted among civilians and high-risk occupation groups with mixed results. The purpose of this study is to examine the social validity of the CISM model for school-based crisis intervention as perceived by school psychologists and school social workers trained in the model. The results suggest that the CISM Model had a positive effect on service delivery, but the training itself did not adequately address the developmental appropriateness or the cross-cultural appropriateness for school-based application. © 2007 Wiley Periodicals, Inc. Psychol Schs 44: 765–777, 2007. [ABSTRACT FROM AUTHOR]

Aims: The potentially debilitating effect of posttraumatic stress disorder (PTSD) has created much interest in early intervention strategies that can reduce PTSD. This review critiques the evidence for psychological debriefing approaches and alternate early intervention strategies. Methods: The review critiques the randomized controlled trials of psychological debriefing, and early provision of cognitive behavior therapy. The latter approach involves therapy attention on acutely traumatized individuals who are high risk for PTSD development, and particularly in people with acute stress disorder (ASD). Results: Psychological debriefing does not prevent PTSD. Cognitive behaviour therapy strategies have proven efficacy in reducing subsequent PTSD in ASD populations. Conclusions: Despite the promising evidence for early provision of CBT, many people do not benefit from CBT. This review concludes with consideration of major challenges facing early intervention approaches in the context of terrorist attacks and mass disasters. [ABSTRACT FROM AUTHOR]

Dissemination of effective early interventions following trauma is necessary to ensure the provision of the best possible care in a timely manner. To achieve this, agreement from all key stakeholders is required regarding the messages to be disseminated and the means of dissemination. This article is based on a National Institute of Mental Health sponsored symposium on the dissemination of early interventions at the 21st annual meeting of the International Society for Traumatic Stress Studies in Toronto in 2005. The current knowledge base regarding the effectiveness and dissemination of early interventions (defined here as those that are begun within the first 3 months after exposure) following trauma for children, adolescents, and adults is considered. [ABSTRACT FROM AUTHOR]

Objective: To determine whether an early intervention using a psychological debriefing format is effective in preventing psychological distress in child road traffic accident survivors. Design: Randomised controlled trial. Setting: Accident and Emergency Department, Royal United Hospital, Bath. Subjects: 158 children aged 7–18. Follow-up assessment completed eight months post accident with 132 (70/82 of the experimental group and 62/76 in the control group). Main outcome measures: Self-completed measures of psychological distress; fulfilment of diagnostic criteria for post-traumatic stress disorder. Results: Children in both groups demonstrated considerable improvements at follow-up. The early intervention did not result in any additional significant gains. Conclusions: Although children in this study made significant improvements it is unclear whether these are better or worse than natural recovery rates. The specific intervention did not result in additional gains although the structured assessment provided for both groups may have been helpful in reducing subsequent pathology. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to determine if two debriefing sessions following an operative delivery could reduce a woman's fear of future childbirth. Design Prospective randomised controlled trial (RCT) with two arms comparing debriefing, aimed to reduce fear of future childbirth, with standard care after birth. Setting District General Hospital with 2500 deliveries per year. Sample Three hundred and nineteen mothers who delivered a first child by operative delivery (i.e. forceps, vacuum or emergency caesarean section). The study took place at Huddersfield Royal Infirmary, from January 2002 to July 2003. Methods Debriefing by community midwives specifically trained in postpartum debriefing at 10 days and 10 weeks. Main outcome measure Fear of childbirth was assessed using the Wijma Delivery Expectancy Scale (WDEQ). WDEQ scores were measured 10 days, 10 weeks and 20 weeks following delivery. Results Fear of childbirth as measured by the WDEQ was lower throughout the study for the debriefing group. However, it never reached statistical significance in the short term [10 days debriefing = 94.5, control = 97.5 ( P= 0.295), 10 weeks debriefing = 92.0, control = 97.9 ( P= 0.076), 20 weeks debriefing = 90.9, control = 97.4 ( P= 0.057)]. Conclusion This study shows in the short term there was no significant difference in the WDEQ fear of childbirth scores. The debriefing group were showing a tendency for lower scores. Long term follow up of these cases may be more relevant. [ABSTRACT FROM AUTHOR]

Although students are often attracted to the profession of psychiatric nursing, they are rarely prepared for the realities associated with clinical seminars and direct clinical practice. Subsequently, student nurses commonly report the resurgence of painful life events or symptoms of psychological injury when learning about or witnessing patient behaviour. This paper underlines the importance of student-faculty collaboration when promoting and monitoring student nurse well-being. Along with providing descriptions and case vignettes depicting two specific forms of psychological injury, this paper suggests practical steps that are designed to promote student nurse well-being. [ABSTRACT FROM AUTHOR]

BACKGROUND: The evidence for postnatal debriefing generally lacks clarification of what postnatal debriefing constitutes. This is true of the recommendation in the United Kingdom for midwives to undertake 'active postnatal debriefing' (Department of Health 1999). AIM: The study aimed to explore current practice and describe the provision of postnatal debriefing in two health regions of England. METHODS: A descriptive survey using cohort sampling was undertaken using a self-report questionnaire which was sent to each maternity unit in the two regions (n = 46). A response rate of 93% (n = 43) was obtained. The questionnaire collected information about the maternity units and their provision of 'postnatal debriefing'. A list of debriefing descriptors formed the basis of the questionnaire, and comprised activities that various authors had included in their definitions of debriefing. RESULTS: Responses indicated that 38 (88%) of maternity units offered women an opportunity to 'debrief' by discussing their experiences of maternity care. The provision of this service fell into three distinct sub-groups: firstly, those who provided a service which is in keeping with debriefing, however not all the maternity units actually called their service debriefing; secondly, those who provided a service which is fundamental postnatal care, usually called routine postnatal care; thirdly, those who provided a service which was inconsistent and neither debriefing nor postnatal care. This inconsistency was also reflected in the names chosen for the service. CONCLUSIONS: The findings of this study support previous claims that confusion about postnatal debriefing continues. Recommendations for practice are made with the intention of promoting a consistent approach; this would also enable further research and evaluation to be conducted. [ABSTRACT FROM AUTHOR]

The law places increasing responsibilities on organizations to protect its workforce from psychological injury. This paper looks at the development of British law relating to traumatic stress and explores a growing concern of clinicians that the law and the legal processes themselves may increase the psychological injury of victims of traumatic stress. The statutory requirement for organizations to provide effective support for employees following a traumatic incident is enshrined in law. However organizations are confused by the conflicting statements on the effectiveness of debriefing and trauma counselling. [ABSTRACT FROM AUTHOR]

Population-based approaches to the primary prevention of posttraumatic stress disorder (PTSD) focus on the prevention of the stressor itself. Policy decisions also consider ways to allocate resources to best reduce potential damage from traumatic stressors and to ameliorate any resulting harm. A balance between broad risk prevention approaches and narrower treatment and recovery strategies can redistribute the risk of exposure and lead to fewer cases. Understanding that PTSD and its costs affect not only individuals who seek care, but also many others whose lives overlap with these individuals as well as society as a whole, further informs and shapes prevention decisions. [ABSTRACT FROM AUTHOR]

Objective: To identify literature concerning the effectiveness of psychological debriefing (PD) and analyse results according to different criteria of success and different uses of the intervention format. Method: Literature search was made in databases PubMed, PsycInfo and Psychlit. Twenty-five studies were selected for a thorough description. Forty-two studies provided additional information. Results: Results indicate that, in general, debriefing does not prevent psychiatric disorders or mitigate the effects of traumatic stress, even though people generally find the intervention helpful in the process of recovering from traumatic stress. The intervention holds potential as a screening procedure, and there may be economic arguments for continued use. When used with adherence to traditional descriptions of treatment group, events, group format, leadership and time spent, a preventive effect emerges. No tendency according to timing was found. Conclusion: Current uses of PD are problematic. The concept needs to be redefined, and the scope of application must be revised. The objectives for use need to be clarified. [ABSTRACT FROM AUTHOR]

This study was designed to explore the use of critical incident stress debriefing as a therapeutic intervention following traumatic life events. A case study approach was used to allow the researchers to adopt a more flexible and overtly involved stance. Initial contact took place 24 h following the traumatic life experiences of three women. Critical incident stress debriefing was provided and data were collected and recorded within an ethical framework. Six months following the traumatic life experiences the women were interviewed again to explore their perceptions of the intervention that was provided. The results demonstrated positive outcomes. The women concluded that the debriefing intervention provided a safe forum for them to explore their needs, process their experiences and create constructive narratives. A carefully constructed critical incident stress debriefing intervention was used within the context of its objectives and acknowledged limitations. The study was small and generalizations cannot be made to other individuals who experience similar tragedies. Nevertheless, evidence from previous research coupled with the findings from this study suggests that mental health nurses might benefit from being educated and trained in critical incident stress debriefing. Further research needs to be carried out to explore the use of different models of stress debriefing applied to special circumstances. The goal of such interventions should be to alleviate symptoms and to prevent the development of a full-blown post-traumatic stress disorder. [ABSTRACT FROM AUTHOR]

Seventy-seven civilian employees who were victims of robbery were randomly assigned to either an immediate (<10 hr) or delayed (>48 hr) debriefing group, using the J. Mitchell (1983) CISD protocol. Scores on the Posttraumatic Stress Diagnostic Scale were obtained at 4 time intervals: debrief, 2 and 4 days postdebrief, and 2 weeks postrobbery. The number and severity of symptoms did not differ at debrief, but were lower for the immediate than for the delayed group at each subsequent time interval. The number and severity of symptoms declined across time intervals; however, although this reduction was pronounced for the immediate group it was minimal for the delayed group. The results supported use of immediate debriefing with this type of incident and victim. [ABSTRACT FROM AUTHOR]

Aim of the paper. This paper proposes alternative theoretical frameworks for conceptualizing supervisory relationships in clinical settings where professional development is the key activity. In discussing findings from the research, paradigm examples of students' mentor experiences will be used to illustrate socio-cultural theories of learning and their relevance to professional education in clinical settings. Background rationale. The concept of a theory-practice gap dominates approaches to preparing professionals for their future role. With increasing emphasis on work-based learning one of the many strategies designed to support students and professionals is supervision. This strategy has had mixed success. In many instances this is because of insufficient numbers of suitably experienced and prepared staff. Another factor is how supervision has been conceptualized. In professional education the term mentorship is often used synonymously with preceptorship and supervision. These terms are all concerned with activities intended to foster professional and educational development, and in many instances the learner is a novice working in an unfamiliar setting over a predefined period of time. Research aims and design. This longitudinal study using a Constructivist/Naturalistic paradigm was designed to investigate factors influencing the professional development eight preregistration nursing students' during their practice experiences. A multimethod approach to data collection was used. An extensive literature review of nurse education texts was conducted. Research findings. The most significant influence was found to be effective mentorship. Characteristics of successful mentorship are best explained using frameworks derived from socio-cultural theories. Concepts of sponsorship, legitimate peripheral participation, scaffolding and zone of proximal development (ZPD) offer a more effective means to understand and implement an educational partnership for work-place learning. [ABSTRACT FROM AUTHOR]

AIMS OF STUDY: The aims of the study were to carry out a critical incident study to: (1) Describe what nurses consider to be spiritual needs; (2) Explore how nurses respond to the spiritual needs of their patients; (3) Typify nurses' involvement in spiritual dimensions of care; (4) Describe the effect of nurses' intervention related to spiritual care. BACKGROUND: In the caring professions a focus on individuals as bio-psychological-spiritual beings is gaining recognition and this notion is based on the premise that there should be a balance of mind, body and spirit for the maintenance of health in a person (Stoll 1979). Emerging research highlights the importance of spiritual care in nursing and suggests that there is scope for improving this dimension of care in order to improve the quality of life for many patients. However, there is very little evidence about how nurses respond to the spiritual needs of their patients. Therefore the purpose of this study was to map by critical incident techniques how nurses construct and respond to patients' spiritual needs in a variety of clinical settings. METHODS: Critical incidents were obtained from 115 nurses. The data from these incidents were subjected to content analysis and categories were developed and described. The emerging categories were subjected to peer reviews to ensure reliability and validity of findings. FINDINGS: The findings suggest that there is confusion over the notion of spirituality and the nurse's role related to spiritual care. A variety of approaches to spiritual care emerged in this study from the critical incidents derived from nurse respondents. These were categorized as 'personal', 'procedural', 'culturalisit' or 'evangelical'. There was an overwhelming consensus that patients' faith and trust in nurses produces a positive effect on patients and families, and nurses themselves derived satisfaction from the experience of giving spiritual care. In this respect, spiritual care interventions promote a sense of well-being in nurses as well as being a valuable part of total patient care. CONCLUSION: The study concluded that there is scope for developing an ideal model of spiritual care using the critical incident data from this study. [ABSTRACT FROM AUTHOR]

A systematic literature search/review was undertaken of brief early psychological interventions following trauma. Only six randomized controlled trials were found, and none of these included group interventions. Of the six trials, two studies associated the intervention with a positive outcome, two demonstrated no difference on outcome between intervention and non-intervention groups, and two showed some negative outcomes in the intervention group. This review suggests that early optimism for brief early psychological interventions including debriefing was misplaced and that there is an urgent need for randomized controlled trials of group debriefing and other early interventions. [ABSTRACT FROM AUTHOR]

The article discusses a research using a psychological diary technique to investigate psychosomatic relationships. The diary can be flexible in format and yields objective scores as well as some qualitative data. The objective scores are based upon a factor analysis of items in the diary. The principal factors were labeled "Interpersonal Stress," "Depression-Isolation," and "Physical Complaints." The diary technique has been used in several studies. These studies include research on psychosomatic relationships, a study of the effects of marijuana use and studies of patients hospitalized for heroin addiction.

Critical Incident Stress Debriefings have become an intervention method used in various cultures, countries and groups following critical incidents. Although the structure of such meetings has been adequately described, utilization of the group processes involved has received less attention. A model, process debriefing (PD), based on experiences from Europe, is presented. Some differences between the current CISD process in the United States and the Europe based model are outlined. Various factors that impact the process of debriefings are discussed with a special emphasis on leadership, and implications of these group process variables for psychological debriefing are presented. It is emphasized that the continued exploration and discussion of process issues is critical to advance the understanding of the critical elements of debriefing. [ABSTRACT FROM AUTHOR]

Stress debriefing has been used extensively following traumatic events; however, there is little evidence of its effectiveness. This paper reports the effects of stress debriefing on the rate of recovery of 195 helpers (e.g., emergency service personnel and disaster workers) following an earthquake in Newcastle, Australia (62 debriefed helpers and 133 who were not debriefed). Post-trauma stress reactions (Impact of Event Scale) and general psychological morbidity (General Health Questionnaire." GHQ-12) were assessed on four occasions over the first 2 years postearthquake. There was no evidence of an improved rate of recovery among those helpers who were debriefed, even when level of exposure and helping-related stress were taken into account. More rigorous investigation of the effectiveness of stress debriefing and its role in posttrauma recovery is urgently required. [ABSTRACT FROM AUTHOR]

The psychological reactions of 50 survivors of the King's Cross fire, which hit London's underground railway system on the 18th day of November 1987, are described. Results are presented for the Impact of Event scale, the General Health Questionnaire (28-item version), the Eysenck Personality Questionnaire and a King's Cross Event Schedule. These are investigated in relation to (a) validity measures, (b) relationships between exposure and personality, and (c) spontaneous de-briefing. Two thirds of the sample had significant levels of psychological distress (meeting the "caseness" criterion on the GHQ). Both personality (neuroticism and L-scale) and degree of trauma exposure were related to subsequent reaction. Spontaneous debriefing was associated with subjective benefit. Transportation disasters present particular problems in relation to research and service delivery. [ABSTRACT FROM AUTHOR]

Sexual abuse survivors often present with a complex and changing symptom picture in which posttraumatic reactions are superimposed on an underlying personality disorder, a combination that makes the establishment of a secure therapeutic relationship difficult. An eclectic blend of principles and techniques is recommended in order to address both aspects of the survivor's disturbance. [ABSTRACT FROM AUTHOR]

Although behavioral researchers in marketing frequently deceive their subjects, relatively few report postexperimental debriefings. We hypothesize that researchers may avoid debriefings because (a) they feel their deceptions are so minor that debriefings are unnecessary, and (b) they fear possible negative reactions when subjects learn of the deceptions. We present the results of an experiment in which we measured debriefing effects on subjects who received such "mild" deceptions. Our results suggest that researchers have little to fear from conducting debriefings in these situations. We conclude by making several suggestions for administering debriefings and by identifying several issues concerning the effects of debriefings and deceptions that warrant future research. [ABSTRACT FROM AUTHOR]

This paper describes the impact of critical incidents and psychological debriefings on 172 emergency service, welfare and hospital personnel in Australia. Experience of trauma at work was found to reactivate prior trauma in one in two personnel. Psychological debriefing was reported to reduce stress symptoms in almost all personnel who reported stress response. The effectiveness of the debriefing was found to derive, in large part, from talking and in particular from talking with others who had experienced the same situation. [ABSTRACT FROM AUTHOR]

This article looks at the stresses inherent in crisis intervention work in general, and on the effects on psychologists in particular. The authors review debriefing strategies currently used and argue that the needs of psychologists differ from those of other crisis interveners such as police or ambulance workers. They present a debriefing strategy that takes into account the psychologist's need for psychological understanding and integration. [ABSTRACT FROM AUTHOR]

The article gives a detailed description of the debriefing process evolved by two counselling psychologists who work with victims of armed hold-ups. The process is seen in the context of literature relating to post-trauma reactions and the type of interventions that are effective. The authors give details of their procedures and interventions, their reasons for using them, as well as considering broader issues of working within an organizational context. [ABSTRACT FROM AUTHOR]

Cites a study on the importance of de-roling and debriefing in training medical students, using simulation to train the students. Role of debriefing as a defense against traumatic incidents; Potential of de-roling in drawing students on aspects of their personality; Strategies to effectively implement debriefing and de-roling activities.

The efficacy of critical incident stress debriefing (CISD) and psychological debriefing (PD) following potentially traumatising events has recently been challenged after a number of recent randomised controlled trials (RCTs) failed to demonstrate that CISD or PD prevents or reduces the incidence of posttraumatic stress disorder (PTSD). These studies have used measures of PTSD as the principal outcome and have generally not measured comorbid psychopathology, behavioral or social dysfunction. In a recent RCT of group debriefing amongst British soldiers returning from peacekeeping operations in Bosnia, PD had a significant effect in reducing a worrying level of alcohol misuse in the sample. The findings of this study suggest that that it is premature to conclude that debriefing is ineffective and that a broader range of outcome measures should be employed in future trials of debriefing. [ABSTRACT FROM AUTHOR]