Critical Incident Debriefing

1:1 Peer Debriefing

 

“Anything that is human is mentionable, and anything that is mentionable can be more manageable.  When we talk about our feelings, they become less overwhelming, less upsetting and less scary.  The people we trust with that important talk can help us know that we are not alone,”  Fred Rogers

 

People in the helping professions have alway debriefed each other after traumatic events.  It is necessary to care for each other in this way to prevent or mitigate lasting emotional damage.  We either talk out these events or we act them out  through our behavior. Some events may follow us for a lifetime. Debriefing within 24 hrs to 72 hrs has been proven to migrate the damage caused by these traumatic life events (Vander Kolk)

 

Hospitals often call post-code critiques  a debriefing.  A critique and a debriefing are two totally different events.  A critique is all about what went well and what could have been done better.  Its intent to improve the process for next time.  Debriefing is about working through the emotional trauma of an event.  A part of the brain called the Amygdala is the keeper of all the trauma you have experienced throughout your whole life. It is where your personal emotional triggers, and Post Traumatic Stress is stored.

 

Many healthcare organizations don’t use debriefing or even acknowledge that their staff are suffering.  This contributes to a feeling of lack of support and anger.  Some organizations use the the large group debriefing popular in the 90’s.  This approach does not work in most organizations.  Many professionals do not want to discuss  feeling in a group that often facilitated by a stranger. As result they ones most seriously impacted don’t participate.  For this reason we at Resilient Professions recommend a 1 to 1 peer debriefing model.  It is important to note that you many need additional mental health counseling.  If you can’t stop thinking about the event, are sad, withdrawn, anxious or general depressed you should seek additional help.  See the resource page for free or low cost counseling help.

 

Now how do you go about this debriefing technique?  First the one being debriefed ( the Debriefee) and the one doing the debriefing (the Debriefer) must consent to the debriefing.  This can be anyone you trust and agrees to confidentiality.

 

The Debriefers job is the listen and ask clarifying questions.  Is is not their job to fix the problem or give advice. Help the Debriefee explore their own options. Make sure the Debriefee has a self-care plan for the next three to four days.  Schedule a welfare check by phone or in person with Debriefee.  Don’t count on text messages or emails for this check, too much can be lost in the translation.

 

The role of the debrief is to detail the event that happened. Do not go into details that you feel are too graphic or painful to discuss.  Get the permission of the debriefer before telling him/her something that may traumatize them.  This is called slimming someone if you cause secondary traumatic stress in telling the event. You can discuss feeling with out extremely gruesome detail.  Make sure you take a few minutes and focus in on your personal life.  Are there identification factors from your own life influencing your reactions?  Are there personal moral values that have been violated? It is important to put closure on the event you can do this by summarizing some take-a-way thoughts.  You can use a technique called Reframing. List one or more positive thoughts regarding the event.  It might be something that you or your team did well. It may just be that you survived it.  Remember that emotional and physical symptoms can be a normal reaction to an extraordinary event. YOU CANNOT DEBRIEF YOURSELF!  Verbalize and write down a self-care plan and followup meeting.  During this time do not self-medicate with drugs or alcohol.

 

!:! Peer Debriefing Outline

 

1. Obtain Consent/Fair Warning before proceeding.  Pick a convenient time and quiet place.

2. Give general overview events-maintain confidentiality.

3. Give important details Limit disclosure if too graphic.

4. Give first thoughts and reactions after the event

5. Describe feelings

6. Determine identification factors/feelings of moral distress

7. Closure/Take-Away -Refraiming. List one or more positive thoughts.

8. Self-Care Plan for next 72 hours

9. Schedule a follow-up meeting-Welfare Check

 

 

Sources: Jeffery Mitchell, PHD

                Francoise Mathieu, M.ED CCC

                 Diane McKeyhan, RN CFS CISM

                 Bessil Vander Kolk, MD