Debriefing with Staff During COVID-19

It is natural – and to be expected – that clinicians caring for people with a serious illness experience a variety of emotions, such as sadness, grief, and isolation on a “normal" day. The fast pace of our work often leads us to compartmentalize, putting our feelings aside to manage later.

During the COVID-19 pandemic, there has been no time for “later”. On top of the everyday feelings we experience in our work, there is now added exhaustion, moral distress, empathy strain, and stress. The traumatic effects of the pandemic on clinicians require an opportunity to talk about it – to be heard and understood.[1]

Well-being debriefings are small, informal peer-facilitated meetings, which provide an opportunity for clinicians to exchange thoughts and feelings about work issues affecting their emotional health. Planned or spur-of-the-moment, debriefings occur in a variety of health care settings—across departments, specialties, and disciplines. A trained facilitator guides the conversation, allowing a safe, confidential space for peer-to-peer sharing.

It is important to note that well-being debriefings differ from critical incident or traumatic event debriefings, when clinicians meet with specially-trained facilitators who address immediate psychological needs, helping the group process the (usually short term) event, such as a mass shooting or wildfire. Instead, well-being debriefings aim to help participants gain strategies for coping with a long term crisis such as a pandemic in an effort to normalize and legitimize common behavioral and emotional reactions to work that is demanding over the long-term.

Evidence suggests that having opportunities to increase collegial support and affirmation, along with learning coping strategies, can significantly improve the moral resilience of clinicians, in turn improving patient care. And supportive peer connections – the heart of well-being debriefings – promote resiliency and diminish consequences of stress. Intentionally fostering reflection and communication through debriefings also increases collaboration.[2]

Research confirms that ongoing stress and distress affects clinical practice—increasing compassion fatigue, burnout, and the desire to leave the field.[1] Peer-facilitated reflective debriefing sessions offer a powerful solution. They build resilience by providing an opportunity for clinicians to give voice to the difficult and morally-conflicted nature of their work. Saying these things out loud, in a safe setting with peers who are going through the same thing, brings the feelings to conscious awareness. Conscious awareness gives clinicians the self-control needed to protect patients from our unconscious emotion.[3]

For example, during a recent debriefing session facilitated by a colleague, a nurse described how she dreaded coming to work, because she feared she would bring the infection home to her family. She shared that she frequently considers quitting her job for the safety of her loved ones. These feelings were validated by her peers, who had similar feelings – this served as a relief to the nurse, and the others who hadn’t had a floor to voice these feelings before the session. This led to a healthy discussion of ways individuals in the group coped with these feelings. The mood was much lighter at the end of the session, with some shared laughter between participants.

Feedback about well-being debriefings has been positive. Here's what clinicians have to say:

• "As a provider, my participation in debriefings has helped me develop better relationships with the nursing staff — both by understanding how I can support the nurses, but also by being a part of us all sharing our common experiences on the unit.” - Hospitalist APP, PA, Duke University Hospital
• "The positive impact of the debriefing sessions cannot be overestimated among the MICU house staff [...] To have a time and a safe space in which to talk through their experiences, feelings, and emotions is invaluable.” - Dr. Chris Cox, Director, Medical Intensive Care Unit, Duke University Hospital

COVID-19 has brought isolation, visiting restrictions, markedly increased caseloads, being witness to unremitting suffering and death, and the uncertainty about whether and when this will ever end. This has had visible and invisible effects on us. Many of us worry about how we will recover. Many are burned out and morally exhausted. Some are leaving clinical work. We need to take action now.

The stress of the pandemic requires health care organizations to adopt new emotional PPE resources for their employees, including debriefings. We need to champion evidenced-based, easy-to-launch strategies that quickly and effectively offer relief to the field. Debriefings are an effective, low-cost, scalable way for health care professionals to take care of each other in real time, addressing real issues.

Palliative care clinicians are in an excellent position to serve their colleagues by championing and facilitating debriefings within their organizations. In fact, drawing on their communication skills expertise, many palliative care social workers are already leading debriefings for their teams. By training more palliative care clinicians to be facilitators, our field can exponentially increase the availability of this tool.

That’s why CAPC encourages clinicians and their organizations to learn to adopt debriefings. Read below to learn about the tools and technical assistance CAPC has developed to help expand the availability of debriefings:

• CAPC’s new facilitator training manual, “Well-Being Debriefings for Health Care Workers”, outlines steps for implementing and facilitating well-being debriefings within your institution. Download
• Peer facilitation training, via an on-demand two-part webinar series, helps to build the skill sets of clinicians who can bring debriefings to their workplaces. Watch parts one and two.
• Regularly-scheduled virtual debriefing sessions will be hosted by trained peer-facilitators (starting Spring 2021), who will provide a safe, supportive hour for those who do not have debriefings available in their workplace.