Making the Most of a Bad Patient Outcome

Nurse debriefing is an effective method of coping with a negative patient outcome as well as a learning tool.
Nurses know all too well that not every patient is going to have the outcome they were working towards. These tragic endings can affect the psyche of every person involved, especially in a situation where the death of the patient could have been avoided. As a nurse, it is natural to feel certain emotions after these events, and debriefing can help in putting what happened into perspective.

Common thoughts that run through a nurse’s head after the unforeseen death of a patient – or even a near miss – are typically regretful in nature. You way agonize over choosing one method over another, or assuming that another nurse had followed a certain procedure. Rather than allow that self-doubt to stop you in your tracks, take the time to debrief and learn from mistakes to avoid them in the future.

What is Debriefing?

The term debriefing is used in many different work environments, especially in those where multiple people have come together to achieve the same goal. At certain milestones, or when the task has been completed, that team of people get together and summarize the entire process and final result. This is used most often to recognize areas in the process that could be improved on for the next similar project.

As a nurse, that common goal you have is to act in the best interest of the patient to restore their health. Debriefing is usually a strategy used by a risk management team after something goes wrong when trying to reach that goal. All interested parties are brought together and walked through what happened in order to find out what happened during the care of the patient that either caused a sudden deterioration in health or even death.

How Debriefing Assists Nurses

You do not deliberately set out to make mistakes, nor do your coworkers. Yet, the unfortunate truth is that sometimes we do, and it can have tragic consequences. Most mistakes are the result of one of two things; either someone lacked the necessary technical expertise or there was a problem with communication and teamwork. Debriefing can help the entire team find out what type of mistake it was, and develop a strategy that ensures it does not happen again.

In order for a debriefing to have the desired positive result a few rules should be followed:

• A debriefing should take place as soon after the event as possible. This way all of the events are still fresh in everyone’s mind and easy to recall. The longer you wait to bring everyone together, the less likely it is that you will all be able to reach the same conclusion.
• The details disclosed during a debriefing should remain confidential. Participants have to feel comfortable in knowing that what is discussed in the debriefing will not become common knowledge to the entire floor, clinic, or nursing staff. In situations where others could benefit from knowledge gained, it should be presented in a way that does not name any one or group involved.
• A nurse risk manager or risk management team should lead the debriefing. Structure should be applied so that one person gets to speak at a time, and all thoughts on the event are heard.
• Don’t allow the focus to be on what was done wrong or who did it. As soon as the problem has been identified, shift the conversation away from the who and what and work on the how to fix the problem.
• Nurse debriefings should be conducted in a non-threatening environment. The goal is to obtain important information that could help others so you want everyone involved to feel they can talk freely. The conversation should start with those who have less seniority so that they don’t feel any pressure to agree with what their superiors are saying.
• Don’t make a debriefing a long and drawn out affair. If your facility is in the habit of doing a quick debriefing after each case, these should take only 2 or 3 minutes. For major events, such as when a patient codes unexpectedly, no more than 15 minutes is usually needed to determine what went wrong and how to fix it.

The very act of talking about a difficult case, and even reliving it with the others who experienced it with you, will help you to deal with what happened quickly so that you can move on from it. These are constant small traumas you are being exposed to, and the best way to keep your head together after them is by releasing any frustration or doubt.

Having debriefings after a positive outcome can also help the psyche of a nurse. Remain humble in your position and constantly aware that there is always room for improvement. If something about a specific patient or procedure stands out to you, take a moment to share your thoughts with your peers.

A formal debriefing may not be conducted after each hard case you work, but you can still follow these steps on your own to give yourself peace of mind. Talking out the steps you followed, and understanding where you could have done better will not only make you a stronger nurse, it will give you the closure needed to continue on to the next patient.