Contemporary Themes in

Healthcare Policy and Practice

Week 9 Session 2- Violence in the workplace
Contemporary Themes in
Healthcare Policy and Practice
Module Leader- Martin McCracken Joyce
Martin.Joyce@london.aru.ac.uk
aching Team-
By the end of this session

• Students will be able to define debrief in healthcare

• Identify two models of clinical debrief

• Apply one model of clinical debrief in relation to a violent or

aggressive incident
Debrief
Debriefings originated in the military
and are a process of reviewing
information and performance, with
opportunities to assess activity once
participation is complete. In addition to
military debriefing, types of debriefing
include:
• experiential learning
• crisis intervention,
• psychological debriefing
• critical incident stress debriefing

(Gilmartin et al. 2020)

Debrief
There has been widespread debate around debriefing
following traumatic events and the usefulness in day-to-day
practice across a wide range of settings. Working in areas such
as emergency departments and in critical care areas,
healthcare workers are exposed to traumatic events,
witnessing death, the effects of child abuse and aggression
and violence.
Benefits
• Debriefing can reduce the possibility of psychological harm
by talking about what has happened; facts can be reviewed,
misconceptions corrected, as well as valid and fair
observations taken on board.
• Thus the information can be used to analyse the critical event
and help prevent further untoward incidents.
• Even in the absence of an actual traumatic event, debriefing
takes into account a stressful work environment and provides
a valuable opportunity to share thoughts, feelings and
experiences.
(Adler et al., 2009)
What makes a debriefing effective?
1. Supportive environment
2. Allows for reactions and emotions
3. See the event from another colleagues perspective
4. Focus on improvement or sustaining excellence
Types of debrief
The After Action Review (AAR)
Structured approach to undertaking a de-brief and
constructive way of identifying lessons identified from the
incident. An AAR is constructed of four questions:
1. What was expected to happen?
2. What actually occurred?
3. Why was there a difference?
4. What can be learned?
(Cronin & Andrews, 2009)
Link to NHS Debrief Template
Promoting Excellence and Reflective Learning
in Simulation (PEARLS)
The PEARLS Debriefing Framework and Script represents a
blended approach designed to promote effective debriefing
by integrating three educational strategies to promote learning
during debriefings:
1. Learner self-assessment

2. Focused facilitation to explore learners’ perspective

3. Directive Feedback and Teaching

(Eppich & Cheng, 2015)
Directive Self- Focused
Feedback Assessment Facilitation
Facilitator notes
Facilitator notes
Learner explores what performance gaps and
performance gaps and
went well and what to investigates cognitive
offers solutions for
change frames before
future performance
discussing

What are the characteristics of these

methods, and when should they be used?
Break
Group exercise
• Use AAR or PEARL to debrief your team. Use the de-
escalation exemplar situation from the last session as your
incident.
• Prepare a role play between your group members. Each
group member will play a member of staff.
• Ensure to pick a facilitator to lead the discussion
• Prepare to role play after group discussions
References
• Adler A., Castro C.A., McGurk M.S., 2009. Time-Driven Battlemind
Psychological Debriefing: A Group-Level Early Intervention in Combat. Military
Medicine, Volume 174, Issue 1, January 2009, Pages 21–28, Available
at: https://doi.org/10.7205/MILMED-D-00-2208 [Accessed September 2020]
• Cronin G. and Andrews S., 2009. After action reviews: a new model for
learning. Emergency Nurse, 17(3), pp. 32-35.
• Eppich, W. and Cheng A., 2015. Promoting Excellence and Reflective Learning
in Simulation (PEARLS). Simulation in Healthcare. 10, 2, pp.106-115.
• Gilmartin, S. Martin L. and Kenny S., 2020. Promoting hot debriefing in an
emergency department. BMJ Open Quality. [pdf] Available at:
https://bmjopenquality.bmj.com/content/9/3/e000913 [Accessed
September 2020)
• Images from unslaph.com
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