Critical Incident Stress Debriefing in the ICU; Feasibility, Usability and Satisfaction

Critical incident stress debriefing (CISD) is a method of stress management that has been used in military, police, fire, and frontline personnel since the 1980s. The purpose of CISD is to help workers in these fields debrief and manage stress that can arise in their jobs due to critical incidents. A critical incident can be described as an event that happens suddenly and that disrupts a person's feeling of control in their surroundings. If not managed appropriately this stress can lead to more serious conditions such as post-traumatic stress disorder (PTSD), thus the aim of CISD is to prevent unmanaged stress leading to serious problems. CISD can be adapted and used in healthcare settings but is underutilized. Healthcare workers, especially those that work in Intensive Care Units (ICU) are frequently exposed to critical incidents. The underutilization of CISD can put ICU workers at higher risk of developing undesirable consequences of mismanaged stress. At a local tertiary hospital, no guideline for CISD exists in an ICU. The purpose of this project was to create a guideline that would allow ICU staff to hold debriefing sessions in their unit following critical incidents. This was accomplished by the following objectives: 1) A guideline was developed that ICU staff could utilize for CISD in their unit, 2) The guideline was presented to key stakeholders in the ICU, 3) The guideline was revised after feedback was obtained from stakeholders of the ICU, 4) The feasibility, usability and satisfaction of the CISD guideline was evaluated by a survey that was provided to 30 ICU staff, 5) The project details were disseminated to a broader audience. The literature shows that there is significant underutilization of CISD in healthcare settings. There are many barriers to CISD in healthcare settings including timing of the debriefing, when to hold a session, and who leads the session. The project was implemented and evaluated in a series of steps. The first was to create a guideline. After the guideline was developed and approved it was presented to key stakeholders of the ICU. In the meeting, ideas for implementation of the guideline were discussed. Feedback was obtained on how stakeholders supported the guideline, and how they would like to see the guideline fit into the unit workflow. The feedback from stakeholders prompted minor revisions to the guideline. The guideline was then shared with 30 ICU staff. After staff had the opportunity to become familiar with the guideline a survey was provided evaluating staff perceptions of the feasibility, usability and satisfaction of the guideline content. The final objective of the project was to gather details about the project and disseminate those details to a broader audience at a nursing education conference. The survey response rate was 80% (24/30). Of the 24 responders, 58% (14/24) felt the guideline would be feasible for their unit; 79% (19/24) felt the guideline would be usable; and 71% reported they were "very satisfied" with the guideline content. Barriers included: timing of the intervention, lack of debriefing by a professional, consistency of intervention implementation. Facilitators reported were: a perceived benefit for new staff, method to increase communication, the follow up call/text will close the loop, trial and error period can improve the processes. Further study could be conducted to assess whether or not use of a debriefing guideline leads to decreased stress, increased job satisfaction and higher quality care delivery in the ICU.