Let’s Make Staff Well-Being Debriefings Part of the Health Care Culture

It is expected that clinicians caring for people living 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. Yet often, there is no time for “later”.

Moral distress, empathic strain, and stress are understandable consequences of working in palliative care. Accepting these as natural responses—rather than due to an individual’s inability to manage stress—opens the discussion to adopt sustainable strategies so we can address them.

Well-being debriefings are small, informal peer-facilitated meetings, which provide an opportunity for clinicians to exchange thoughts and feelings about work issues naturally 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 peer 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. In the latter, clinicians meet with specially trained facilitators who address immediate psychological needs and help the group process (usually short-term) events, such as mass shootings or wildfires.

Instead, well-being debriefings aim to validate and normalize difficulty that participants may have coping in this highly relational work; gain strategies for mitigating distress; and increase access to the social support necessary for working in health care.

Evidence suggests that having opportunities to increase collegial interactions between clinicians can improve patient care. And supportive peer connections—the heart of well-being debriefings—promote social support, reduce isolation, and diminish consequences of stress. Intentionally fostering reflection and communication through debriefings also increases collaboration.

Research confirms that ongoing stress and distress affects clinical practice—increasing compassion fatigue, burnout, and the desire to leave the field. Peer-facilitated reflective debriefing sessions offer a powerful strategy to address these factors. They provide an opportunity for clinicians to give voice to the difficult and often morally distressing 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.

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 a MRSA 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

Bearing witness to the suffering and uncertainty that often comes while working in palliative care can create a feeling of isolation in clinicians, which has 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 working with this population requires health care organizations to adopt new health care professional well-being resources  for their employees, including debriefings. We must champion evidence-based, easy-to-launch strategies that quickly and effectively offer relief to the field.

Debriefings are an effective, low-cost, scalable strategy for health care professionals to take care of each other in real time, address real issues, and mitigate real stress.

Peer support meetings can have a direct impact on healthcare worker retention as well. For example, Intermountain Healthcare began a nurse peer group support program which was credited with increasing the nurse retention rate to 97%. Part of this program's success was attributed to “…nurses having an opportunity to bond with peers, share experiences and feel less isolated.”

Palliative care clinicians are in an excellent position to serve their colleagues by championing and facilitating debriefings within their organizations. For instance, 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 and implement debriefings. Read below to learn about the tools and technical assistance CAPC has developed to help expand the availability of debriefings:

• CAPC’s facilitator training manual, “Well-Being Debriefings for Health Care Workers”, outlines steps for implementing and facilitating well-being debriefings within your institution. 
• 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, called "Breaking Point: Debriefing to Address the Challenges of Our Work", are hosted by trained peer-facilitators who provide a safe, supportive hour for those who do not have debriefings available in their workplace.
• Health Care Professional Well-Being, a toolkit which provides additional resources that clinicians and teams can use to support well-being.