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Team debriefings can sustain a healthy working environment after significant events
Poor mental health accounted for 24.6% of all absences from work by NHS staff in England during May 2022, the latest government figures show (NHS Digital 2022).
Emergency Nurse. 31, 4, 19-19. doi: 10.7748/en.31.4.19.s8
Peer reviewThis article has been subject to external double-blind peer review and has been checked for plagiarism using automated software
Published: 04 July 2023
Given the prevalence of anxiety, stress and depression, debriefing following significant events in the workplace should be paramount and is crucial to sustaining a healthy working environment (RCN 2017).
The UK Resuscitation Council recommends that a debrief takes place after every resuscitation attempt. However, in practice this is often only initiated on an ad hoc basis and led by the attending clinician (Gilmartin et al 2020).
Failure to debrief can result in a team having unresolved questions regarding a patient’s care and may lead to a lack of reflection on the performance of the team and individuals, as well as affecting the mental well-being of staff present at the resuscitation attempt (James et al 2022).
Staff with frequently unresolved questions and feelings about decisions made in high-pressure situations are also more likely to experience burnout. However, Rowlands (2021) describes NHS staff burnout as a misinterpreted collection of symptoms which he says amount to moral injury.
He says ‘moral injury may be experienced when a person perpetrates, witnesses or fails to prevent an act that conflicts with their moral values and beliefs’ (Rowlands 2021).
It could be the case that the handling of traumatic events and how the team and its leader respond have a considerable impact on the mental health of the NHS workforce.
Hot debriefing is a process that takes place there and then, after a clinical event. It should be initiated at the safest possible time following the acute period of a patient’s care (Berg et al 2014).
Debriefing is not a new process but its practice has continued to decline due to time constraints, increased demands on services and short staffing (Gilmartin et al 2020).
Brazil and Williams (2021) outline the principles to consider when leading a hot debriefing.
The debrief leader should have an awareness of the purpose of the conversation and the aims at that time. For example, this may be to defuse high emotions or review team performance.
The leader initiating the debrief should give clear instructions and expectations on the location and length of the discussion. They should give the team an idea of the structure of the conversation and encourage, but not mandate, participation.
Cultural factors of ‘stressful situations, social barriers (such as clinical hierarchies, social cliques in the department and different grades of staff having different opinions), pressure to perform, [and] teamwork’ (Cooper 2022) should be considered to affect the likelihood that a debrief will take place and, if it does, its effectiveness.
Riley (2008) raises the notion that the success of a debrief is determined before the process has begun.
For the debrief to be effective the team must feel psychologically safe and not fear punishment or embarrassment for asking questions or raising concerns (Berg et al 2014), otherwise this is likely to undermine the main objective.
This is an abridged version of an article at rcni.com/ed-team-debrief
Further information
Berg GM, Hervey AM, Basham-Saif A et al (2014) Acceptability and implementation of debriefings after trauma resuscitation. Journal of Trauma Nursing. 21, 5, 201-208. doi: 10.1097/jtn.0000000000000066. (Last accessed: 10 May 2023.)
Brazil V, Williams J (2021) How to lead a hot debrief in the emergency department. Emergency Medicine Australasia. 33, 5, 925-927. doi: 10.1111/1742-6723.13856. (Last accessed: 10 May 2023.)
Cooper BH (2022) Exploring the factors that influence trauma team activation in emergency department staff. Emergency Nurse. doi: 10.7748/en.2022.e2133. (Last accessed: 10 May 2023.)
Gilmartin S, Martin L, Kenny S et al (2020) Promoting hot debriefing in an emergency department. BMJ Open Quality. 9, 3, e000913. doi: 10.1136/bmjoq-2020-000913. (Last accessed: 10 May 2023.)
James S, Subedi P, Indrasena BSH et al (2022) Review debrIef: a collaborative distributed leadership approach to ‘hot debrief’ after cardiac arrest in the emergency department – a quality improvement project. Leadership in Health Services. 35, 3, 390-408. doi: 10.1108/lhs-06-2021-0050. (Last accessed: 10 May 2023.)
NHS Digital (2022) NHS Sickness Absence Rates, May 2022, Provisional Statistics. (Last accessed: 10 May 2023.)
Riley RH (2008) Manual of Simulation in Healthcare. Oxford University Press, Oxford, 155-158. https://academic.oup.com/book/24433 (Last accessed: 10 May 2023.)
Rowlands SL (2021) Understanding and mitigating moral Injury in nurses. Nursing Standard. doi: 10.7748/ns.2021.e11703. (Last accessed: 10 May 2023.)
Royal College of Nursing (2017) Debate: Nurse Debriefing. www.rcn.org.uk/congress/congress-events/nurse-debriefing#Report (Last accessed: 10 May 2023.)
Walker CA, McGregor LE, Robinson S (2018) Edinburgh Emergency Medicine: ‘STOP 5: STOP for 5 Minutes’ – Our Bespoke Hot Debrief Model. www.edinburghemergencymedicine.com/blog/2018/11/1/stop-5-stop-for-5-minutes-our-bespoke-hot-debrief-model (Last accessed: 10 May 2023.)
