Personal Impact

Going into the nursing profession, I knew that I would be around death; it is a natural part of nursing. Currently, I am a NICU nurse at St. John’s Hospital. Before that, I was an RN on a neurology floor at Regions Hospital and at a memory care facility, so when I thought about how my first patient death experience would be, I thought it would be an older adult. It isn’t that I believed an adult death would be less impactful; I simply thought I could compartmentalize it in my head; I could tell myself that they had lived a long, happy life and got to tell those they loved goodbye. I did not expect my first patient's death to be a 24-week premature infant. 

As I drove home Thursday, 4/14/2022, at 7:45 pm, I tried to hold back the tears in my eyes. I turned up the music in my car to drown out the sound of the mother’s cries that were on repeat in my head. I told myself just to make it home and then you can start to process what happened, but as I turned right onto East 26th street after pulling out of the Children’s green parking ramp, a flood of emotions poured out of my eyes. I was sad about the loss of life, angry that this new mother now only has one of her twins to take home, confused as to why none of us talked about the death after it happened, and guilty even though no one could have done anything, selfish for feeling the need to grieve even though he was not mine to grieve, and terrified that this experience was going to make me not want to become a NICU nurse.

It took me a while to emotionally and mentally work through my first patient’s death in a healthy manner and I had to constantly remind myself that it was okay not to be okay. My mind constantly replayed reels of unwanted images from the resuscitation room, the grief-stricken parents, and the blank, emotionless stares of everyone around. Currently, I am still working on defining what it means to “successfully” process a patient death since it is such an individualized process and no course or lecture can teach one how to cope. While we all handle death and grief differently, having the skills to process emotionally traumatic experiences like patient death is crucial.

Emotional Trauma and Stress (ETS) Debriefing Tool

Children’s Hospital’s current debriefing tool focuses on the events that took place and helps participants in the event perform an analysis of the facts, outcomes, and possible improvements that could be made. However, the current debriefing tool does fail to address on any level the emotional trauma a traumatic code can or event may have on nurses, especially if it ends with patient death.

To the left is Kendra’s Emotional Trauma and Stress (ETS) debriefing tool. This tool addresses both the important aspects of the events that occurred but also has a heavy focus on the mental health of those involved. This tool can be used independently or concurrently with Children’s current debriefing form to address both technicalities of events as well as the impact they have on the healthcare team.

WHO

• Who should participate in debriefing? Anyone and everyone who is struggling with an event that occurred or their mental health

• Who should be able to request a debriefing? Anyone should be able to request a debriefing session if they believe they would benefit from it. These can be nurses, care assistants, and other healthcare professionals.

• Who should lead debriefing sessions? Currently, debriefing leaders include nurse practitioners or medical doctors. Research has shown that debriefings are more effective when they are peer to peer level; registered nurses should be able to lead a debriefing session for a group of other nurses.

WHAT

• What is a Debriefing? Debriefings were originally created to give a group of individuals a chance to review events that occurred, personal performance in the event, and areas of improvement.

• What should be discussed? Research has proven that debriefing sessions should start focusing heavily on healthcare team members’ ability to deal with the events that took place. Some important topics include but are not limited to: mental health, emotional impact, trauma, mistakes, deeper understanding of what occurred, etc.

WHEN

• When should debriefing sessions take place? Typically, healthcare institutions partake in debriefing sessions following a critical event such as a code or patient death. However, debriefings are more effective the more they are utilized. Therefore debriefings should be held whenever a nurse or healthcare team member feels as though their mental health or emotional stability has been compromised. This can be after a critical event, not feeling heard by the healthcare team, or also simply having a long day at work.

WHERE

• Where should debriefing sessions occur? In a quiet, safe place, where healthcare team members feel comfortable being vulnerable and talking about their emotions and mental health. Having a dedicated debriefing space takes away the “location barrier” that can occur when attempting to start a debrief. If there is no designated space, some debriefing areas can include a conference room, staff break room, etc.

WHY

• Why should debriefing sessions be held? When used effectively, debriefing sessions can prevent psychological harm to nurses and other participants.
  
  Why are they important? By addressing nurses’ mental health before problems such as burnout, depression, or anxiety. Teaching nurses who work in high-stress environments, like the neo-natal intensive care unit, strategies to effectively digest traumatic stressors and provide time to recover can improve their mental health and decrease nurse burnout, and in turn, improve the quality of patient care

Click the button below to learn more about Kendra’s capstone project, view important articles, access the full debriefing tool, and get access to mental health resources.