Call to Action: The Need for a Standardized Emotional Debriefing Model for Clinical Settings

Clinicians bear witness to the trauma medical crises instill on the patient populations they serve. In some cases, the medical crisis may be a first-hand trauma for the clinician, but an often-neglected toll placed on clinicians is secondary trauma, experiencing the suffering of others day-in and day-out (Jacob & Lambert, 2021). Debriefing stressful events is beneficial if not essential to those who work in high-acuity healthcare systems. Many healthcare systems rely on chaplains to provide staff support in times of distress, with chaplains spending a third or more of their time engaged in some form of staff support (Tartaglia et al., 2022). This can be a regulated part of the job but for many, it is lumped into “other tasks as assigned.” When chaplains are responsible for staff support, they may rely on already established programs and materials to provide said support, though this author is unfamiliar with a standard model of an emotional debrief accepted on a national scale.

An emotional debriefing, also referred to as a psychological debriefing “is broadly defined as a set of procedures including counselling and the giving of information aimed at preventing psychological morbidity and aiding recovery after a traumatic event” (Kenardy, 2000). How emotional debriefings are structured and implemented widely varies across healthcare systems. Debriefing models exist in the hospital environment to assess medical issues, operations, and performance improvement. This strengthens the argument for the development of a standardized emotional debriefing. For an emotional debriefing to be successful, clinicians need to know what it entails and why it is beneficial. A multisite study examining the effectiveness of specific emotional debriefing models, and published work to highlight what is successful, may go a long way in making emotional debriefings reputable and seen as beneficial among clinicians. It is time to come together for the betterment of staff support and wellbeing.

Critical Incident Stress Management (CISM) is a multicomponent methodology created in the 1980s as a response to the trauma and impacts of trauma experienced by first responders (Everly et al., 2002). A loose inquiry from this author revealed several hospital systems use an adapted version of Critical Incident Stress Debriefing (CISD), which is just one component of the CISM model. Utilizing a fragmented and adapted model of CISM has the potential to cause more harm than benefit (Everly et al., 2002). The Federal Emergency Management Agency's three-year study of CISD revealed no significant impact, positive or negative, between the CISD group and the control (Harris et al., 2002), yet it appears to be the most popular model practiced in healthcare systems. There is a need for structured and directed support for clinicians; that structure and direction should be created with direct patient care clinicians in mind.

When a system is in chronic stress, it creates a barrier for clinicians to access support, even when that support is available (Smith et al., 2022). In formulating a standardized emotional debriefing model, there are several factors to consider. Normalization and accessibility should be prioritized as key needs in instituting an emotional debriefing model in a healthcare system. Clinicians are “more likely to access practical and social support” (Sutton & Norton, 2022) therefore the emotional debriefings should be structured with peer involvement in mind and scheduled for a time that meets the needs of clinicians attending the debriefing. Installing emotional debriefings as a regular and standard response for clinics/units experiencing increased secondary trauma enhances accessibility and, potentially, a clinician's willingness to participate. Normalizing emotional debriefings in response to the chronic experience of secondary trauma may mitigate endemic stress, benefiting the healthcare system as a whole.

Chaplains provide staff support in many healthcare systems and should participate, if not lead, in research and the formation of staff support resources. Few publications are available regarding staff support to which publications further dwindle concerning emotional debriefs in the clinical setting. It is time for collaboration across institutions and action from those in the spiritual care discipline. Distress and other impacts of secondary trauma are not going away, so the focus needs to be on how to address secondary trauma and provide support in a way that is beneficial for clinicians’ well-being. An emotional debriefing model created using research data and insight from those charged with providing staff support has the potential to impact clinician wellbeing positively and alleviate some of the burden secondary trauma places on healthcare systems. The need is here, the time is now, and chaplains should take on this charge.