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Critical care nurses’ decision making in regard to critical incident stress debriefing Ayer, Ellen Roberta


Critical care nurses (CCNs) are exposed to death, grief, suffering, and moral distress on a daily basis as they care for critical care patients who have life-threatening disorders or health crises. CCNs cope with stressors as part of their profession, but certain events can trigger unusually strong emotional reactions in CCNs. These events are known as critical incidents. There are numerous anecdotal and opinion pieces in nursing literature that detail the benefits of Critical Incident Stress Debriefing (CISD) to assist CCNs in coping with the effects of critical incident stress in the workplace. Although CISD is known to have many benefits, this type of debriefing is not always possible or appropriate for CCNs because they or their peers must decide to initiate the CISD by reporting the critical incident to CISD debriefers. The purpose of this research was to ascertain how CCNs in an adult intensive care unit decide whether to access critical incident stress debriefing. The recognition-primed decision (RPD) model guided this study in determining the decision-making strategies used by CCNs after a critical incident had occurred. The RPD model is an example of a naturalistic decision making (NDM) model. The research design of critical decision method was used to elicit aspects of CCNs' experience with critical incidents and their decisions on how to manage this experience. The research findings provided an understanding of the decisions CCNs make in response to critical incident stress and the factors that influence those decisions. The participants identified three decisions made in response to critical incident stress: (a) attend a CISD; (b) debrief with colleagues; and (c) avoid debriefing. Implications of this research focus on the need for the recognition of the cost of CCNs' personal emotional investment and the need for ongoing education in regard to CISD. Further research is indicated to monitor the outcomes for onsite, defusing and to determine what knowledge is helpful for management to aid nurses with critical incident stress.

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