Immediate debriefing

Debriefing is an information sharing and event processing conversation amongst peers with the intention of informing each other and assisting each other to deal with a particular event (Hanna & Romana, 2007:38). Immediate debriefing has been identified by the participants as a support strategy that may assist nurses in dealing

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with end-of-life issues in the intensive care unit. Various forms of debriefing had been experienced by the participants. Some participants had received a debriefing session a few weeks after the deaths of patients. Some participants verbalised that they had never been part of a debriefing session following the death of a patient. Participants verbalised the effect and value of the debriefing sessions, as illustrated in the following quotes.

“If it had been done that same week it would have been helpful, but, um, ja... I think debriefing does help, but it needs to be done in a certain time frame, or else it’s kind of pointless.”

Generally participants felt that debriefing should occur immediately after the death of the patient. Some participants stated that debriefing should occur at the bedside of the patient.

“You know we’ve got debriefing mechanisms of which people are really sometimes not keen to go to these formal things. You know debriefing is something that should be done at the bedside.”

“Personally I would think... um, debriefing would be a nice thing to...because different people on the shift might have felt or worked differently.”

It is necessary to acknowledge that some participants were concerned as to how debriefing would be conducted in the unit owing to the variety of cultures and different personalities present. It is noted that nurses are not always willing to deal with emotions that are painful.

“I think like, like almost like a type of debriefing could be good. Um, but I think also that might be challenging in the unit, because so many people don’t really want to face their emotions, or they kind of put it aside. So, but I do think that could be a good thing, because talking to others, who actually understand and who go through the same thing you go through, um, might be, might be different, or might be helpful in the sense that people look at it from different perspective, or from how this one feels,

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and that one feels. And sometimes that can kind of make it a bit easier on you. Um, ja, I do think that maybe some sort of debriefing kind of session, even just chatting to the unit manager if you feel that, um, a certain case, or patient really kind of affected you in a big way, you know.”

Furthermore, participants verbalised that they found talking to colleagues about how they felt about the experiences had helped them to deal with their thoughts and emotions. It was found that it was easier to talk to work colleagues than to family members.

“I speak mostly with the staff because they, they know what you are going through. I do sometimes however speak at home about it as well to my family, but they don’t understand, you know, what we go through, um, as much as your colleagues do.” “I think chatting to your colleagues about how they are feeling and what their views are is very helpful. Um, and I think there is a lack of that in ICU. It’s not a structured thing, um, planned way of dealing with it, but I think it definitely helps.”

“Pray...ja, well, while I’m there doing this, and at home, because I feel if you don’t, you can’t be here. (participant holding back tears and speaking quietly). How can you nurse if you don’t have that. You have to be grounded. And another thing is, um, your family is separate from your work. So...and your kids are young...so I can’t go home and cry there, because it’s separate. So my time from when I get in the car here and I get home, I cry, that you can see tears. I’m just about drowning in my car. And by the time I get home my next role starts. Now I’m a mother, a carer for them... And I have to push it back in my mind and focus on them.”

Most of the participants acknowledged the presence of an institutional support system available to them, yet none had ever accessed this system. Knowledge and education regarding the support systems available to the staff and how to access the support system should be encouraged in order to better inform nurses.

“But I think we can make a difference in it. You know that I never ever want to die alone in an ICU. I think we can make the experience for the patient so much better if

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we the nurses have the knowledge and the skill to do that”.

“I think every form of new information coming in to teach you better coping skills will always improve who you are as a nurse. It will better what you can mean to the patient’s family in the end.”

Ranse, et al (2010:5) acknowledged the importance of communication amongst colleagues, as well as the importance of debriefing when dealing with end-of-life issues. Debriefing assisted nurses in acknowledging their thoughts and feelings and learning to deal with the emotions experienced when dealing with end-of-life issues. Furthermore, debriefing allowed nurses to gain knowledge from other nurses‟ experiences and expertise. Debriefing had a positive effect on the nursing staff and their attitudes toward dealing with end-of-life issues in the intensive care unit.