Critical Incident Stress Debriefing and Pediatric Nurses
Critical Incident Stress Debriefing and Pediatric Nurses
Everly and Mitchell (2005) delineated seven steps to a good critical incident debriefing (see Table 1). An Internet site exists to provide classes and certification in critical incident debriefing (www.icisf.org).
Controversy exists about the efficacy of CISD, with opponents citing a lack of empirical support (Pender & Prichard, 2008). Supporters of the model cite that quantitative research cannot determine the efficacy of complex interventions such as CISD. There is some recognition of the importance of therapeutic factors in group work, which first appeared in the writings of Corsini and Rosenburg (1955). Three theoretical classes have been identified: cognitive (guidance, self-understanding, universality, and vicarious learning), behavioral (altruism, learning from interpersonal actions, and self-disclosure), and affective (acceptance, catharsis, and the instillation of hope). One study published in the International Journal of Emergency Mental Health (Dominguez-Gomez & Rutledge, 2009) identified prominent therapeutic factors associated with CISD: universality acceptance, catharsis, and expression (Dietz, 2009; Pender & Prichard, 2008). Evidence of the therapeutic factors supports the conclusion that CISD has both affective and cognitive positive impact on those who participate. The CISD process may be better understood in terms of the mechanisms of change that occur or do not occur as mediated through the perceptions of those providing and receiving the intervention (Pender & Prichard, 2009).
The next day the chaplain and social worker sat down with the group of providers who were participants in the child's care. Each person had the opportunity to describe what was seen, done, and experienced in the event. There were tears and descriptions of somatic pain, such as headaches and chest discomfort, and sleeplessness. Feelings of inadequacy were shared. Parents present were afraid that their own children were at risk. Active listening helped. Peer support by colleagues was reflected by hugs. Managers praised the efforts the team showed in trying to save the child. Referrals for those needing extra support were given. At the end of the debriefing, participants walked away somber but renewed.
Seven CISD Protocol Key Points
Everly and Mitchell (2005) delineated seven steps to a good critical incident debriefing (see Table 1). An Internet site exists to provide classes and certification in critical incident debriefing (www.icisf.org).
Controversy exists about the efficacy of CISD, with opponents citing a lack of empirical support (Pender & Prichard, 2008). Supporters of the model cite that quantitative research cannot determine the efficacy of complex interventions such as CISD. There is some recognition of the importance of therapeutic factors in group work, which first appeared in the writings of Corsini and Rosenburg (1955). Three theoretical classes have been identified: cognitive (guidance, self-understanding, universality, and vicarious learning), behavioral (altruism, learning from interpersonal actions, and self-disclosure), and affective (acceptance, catharsis, and the instillation of hope). One study published in the International Journal of Emergency Mental Health (Dominguez-Gomez & Rutledge, 2009) identified prominent therapeutic factors associated with CISD: universality acceptance, catharsis, and expression (Dietz, 2009; Pender & Prichard, 2008). Evidence of the therapeutic factors supports the conclusion that CISD has both affective and cognitive positive impact on those who participate. The CISD process may be better understood in terms of the mechanisms of change that occur or do not occur as mediated through the perceptions of those providing and receiving the intervention (Pender & Prichard, 2009).
The next day the chaplain and social worker sat down with the group of providers who were participants in the child's care. Each person had the opportunity to describe what was seen, done, and experienced in the event. There were tears and descriptions of somatic pain, such as headaches and chest discomfort, and sleeplessness. Feelings of inadequacy were shared. Parents present were afraid that their own children were at risk. Active listening helped. Peer support by colleagues was reflected by hugs. Managers praised the efforts the team showed in trying to save the child. Referrals for those needing extra support were given. At the end of the debriefing, participants walked away somber but renewed.
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