Critical Event Debriefings Can Reduce Oncology Nurses’ Risk of Compassion Fatigue and Burnout
Using a formal framework for a team debriefing after an emotionally challenging critical event can create a positive learning experience, initiate process improvements, and ultimately offer nurses and other healthcare professionals psychological support that reduces burnout and compassion fatigue, ONS members Molly Joyce, MSN, APRN, OCN®, and Joanne Itano, RN, PhD, reported (https://doi.org/10.1188/24.CJON.33-41) in an article published in the February 2024 issue of the Clinical Journal of Oncology Nursing.
Debriefing sessions are an evidence-based way for the healthcare team to review and process a critical event in the moments after, a strategy that provides space to cope with trauma before it builds up, Joyce and Itano said (https://doi.org/10.1188/24.CJON.33-41). Frameworks offer a structured, multistep process with a leader guiding the discussion. Although most healthcare debriefing frameworks are designed for use after simulations, Joyce and Itano said that two have been tested and applied in the clinical setting:
- STOP5: Staff involved in the event stop for five minutes to summarize what happened, discuss what went well and opportunities for improvement, and point to future actions that will help ensure those improvements can be attained.
- Post-Code Pause: Use a moment of silence and two focused questions to identify areas for improvement and address stress or psychological trauma for staff involved in the event.
Through a case study, Joyce and Itano demonstrated (https://doi.org/10.1188/24.CJON.33-41) how nurses and other healthcare professionals can use STOP5 in clinical practice. Mr. Johnson, a 58-year-old patient with metastatic melanoma, went into sudden cardiac arrest during an inpatient stay on the oncology unit:
“While waiting for the code team to arrive, it was noted that there was no backboard in the room or on the code cart. Multiple staff members began talking at once, with many of them shouting. . . . The code team arrived at the same time as Mr. Johnson’s wife, who was returning from lunch. As the healthcare team worked to resuscitate Mr. Johnson, his wife was given no explanation about the events she was witnessing. Ultimately, Mr. Johnson was resuscitated and taken to the intensive care unit. Nursing staff helped his wife pack up their belongings and accompanied her to the intensive care unit, attempting to provide emotional support and reassurance.”
In Joyce and Itano’s case study, the charge nurse immediately gathered the healthcare professionals involved in the event, including members of the code team who were still there. Using STOP5, the nurses engaged in a discussion about the event, noting what went well, what did not, and possible solutions for improvement. On a follow-up survey, staff reported feeling empowered to implement practice changes for the specific challenges they encountered (e.g., the missing backboard, the wife’s trauma).
“As the treatment landscape evolves and patients live longer with cancer, oncology nursing will continue to be a challenging specialty,” Joyce and Itano concluded (https://doi.org/10.1188/24.CJON.33-41). “Debriefing after a patient experiences a critical or traumatic event offers many protective measures for nurses, such as better emotional support, enhanced teamwork, and continual opportunities to improve their practice environment.”
See the sidebar for resources to help nurses manage trauma, burnout, and compassion fatigue and restore resiliency in their clinical practice.