Resuscitation debriefing for nurses at the Accident and Emergency Unit of St Dominique\'s Hospital in East London (South Africa)

Abstract

Background
Successful and unsuccessful cardiopulmonary resuscitation are among the most stressful situations that a nurse has to deal with. Nurses, particularly those who are inexperienced, benefit from a debriefing session after experiencing an event involving a cardiac arrest.

Method
In a qualitative study, nurses working in an accident and emergency unit were asked to participate in an interview on the last resuscitation effort that they either participated in or performed themselves. The debriefing that followed this last resuscitation effort was used to explore the quality of the debriefing that the nurses received. With random sampling on the days of the interviews based on availability, the interviewer asked 12 nurses to participate. The interview was conducted by a trained professional nurse, who followed a semi-structured questionnaire with both open and closed questions.

Results
Twelve registered nurses at the Accident and Emergency Unit of St Dominique's Hospital in East London, South Africa were asked to participate in the study. Two of the nurses, however, declined to participate for personal reasons. The majority of the respondents were between 31 and 50 years old, with five males and five females participating. Seven of the respondents had performed their last resuscitation effort less than one month previously.

Two of the nurses had no recollection of any emotions, while one stated that, after an unsuccessful resuscitation, she or he “felt terribly traumatised and heartsore after the death of the child”, and another stated that, after a successful resuscitation, she or he “felt good, extremely good, because something was done to help the patient”. No respondent experienced any feelings of guilt after a failed resuscitation, while the majority experienced symptoms of anxiety. Three of the respondents experienced anger and one experienced hatred and heartsoreness after a failed resuscitation.

An astonishing 60% shared their feelings on the incident with their spouses. The registered nurses also shared the incident with their mothers, sisters or a friend. A few respondents did not talk to anybody because of confidentiality and because they felt that other people would not understand what they did. Seven of the nurses spoke to someone on the scene, mainly to their colleagues, about the resuscitation effort. Almost everyone talked to their colleagues about their emotions.

According to the registered nurses, the debriefing or discussion should include “a reflection on the correct following of basic life-support protocols”, “any improvements on the resuscitation done”, “any shortcomings during the resuscitation and, if not done in a perfect way, where improvements could have been made, if any”, “this should be done specially for the new staff members” and “a discussion about the emotions of the attendees”.

Conclusion
The research proved that the quality of debriefing that nurses received at the Accident and Emergency Unit of St Dominique's Hospital in East London (South Africa) was inadequate. It is recommended that resuscitation debriefing is expanded to contribute towards the improvement of the outcome of resuscitation on both a national and an international basis.

South African Family Practice Vol. 49 (10) 2007: pp. 17a-17d