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At least 217 records · Page 12Linked to original sources
PubMed1993

Juror stress: identification and intervention.

The impact of stressful life events has been studied extensively in the psychiatric literature. Crisis debriefing techniques have been shown to be effective in decreasing psychiatric morbidity following exposure to these stressful situations. Stress reactions and crisis debriefing have been reported in many groups including combat veterans, survivors of natural disasters and accidents, victims of violence, and law enforcement and emergency personnel who respond to such events. One group that has not been studied extensively is jurors who are exposed to potentially disturbing material introduced as evidence in trials. Stress reactions in jurors and the value of debriefing of juries have been described by us in an earlier work. This paper describes debriefing sessions with three juries exposed to emotionally distressing material during murder trials. In comparing our experiences with these sets of jurors a number of common reactions were identified. These are discussed and a model for jury debriefing is presented.

Adaptation, Psychological↗
PubMed2005

Juror reactions to jury duty: perceptions of the system and potential stressors.

Jurors were surveyed on their general perceptions of the court system and factors that may cause stress immediately after trial, after participating in a post-trial debriefing, and a month after trial. Jurors had an overall positive view of the court system but did report some perceived inequities. The two most stressful elements of jury duty were related to the complexity of the trial and the decision-making involved in the trial, although jurors reported low levels of stress overall. Women reported more stress than men, and trial characteristics such as trial length also affected stress levels. The debriefing intervention was perceived as helpful, but jurors' stress levels were similar at pre- and post-debriefing. Finally, although stress on some measures was lower at the 1 month follow-up, this reduction was not moderated by whether or not jurors received the debriefing.

Adaptation, Psychological↗
PubMed2005

Teaching emergency airway management using medical simulation: a pilot program.

OBJECTIVE: Simulation is a tool that has been used successfully in many high performance fields to permit training in rare and hazardous events. Our goal was to develop and evaluate a program to teach airway crisis management to otolaryngology trainees using medical simulation. METHODS: A full-day curriculum in the management of airway emergencies was developed. The program consists of three airway emergency scenarios, developed in collaboration between attending otolaryngologists and faculty from the Center for Medical Simulation. Following each scenario, the participants are led in a structured, video-assisted debriefing by a trained debriefer. Didactic material on team leadership and crisis management is built into the debriefings. Pediatric otolaryngology fellows, residents, and medical students have participated in the four courses that have been held to date. Participants evaluated the program on a five-point Likert scale. RESULTS: A total of 17 trainees participated in four pilot training courses. The survey data are as follows: overall program, 5.0 (SD, 0.00); course goals, 4.79 (SD, 0.43); realism, 4.36 (SD, 0.63); value of lecture, 4.71 (SD, 0.47); and quality of debriefings, 4.92 (SD, 0.28). Sample comments include: "This is a valuable tool for students and residents since true emergencies in ORL are often life-threatening and infrequent," and "This is a great course-really all physicians should experience it." Overall evaluation was extremely positive and both residents and fellows described the course as filling an important void in their education. CONCLUSION: Medical simulation can be an extremely effective method for teaching airway crisis management and teamwork skills to otolaryngology trainees at all levels.

Airway Obstruction↗
PubMed2003

The functions of art-making in CISD with children and youth.

Very little has been written about the use of art materials in the debriefing process with young children apart from the familiar assumptions of increasing comfort in the situation and providing a more concrete way for young children to communicate. In this study, art-making was introduced as an integral, although optional, component of the debriefing process in order to examine more fully the functions of art-making in this context. This paper describes a research process and findings from a series of debriefings with four different groups of children and adolescents who had experienced either primary traumatic effects (i.e., were present during a traumatic event) or secondary traumatic effects (i.e., were impacted by a trauma that happened to someone else). The analysis of the artwork and of the comments of the participants are integrated within a theoretical framework combining ideas from the fields of art therapy and the treatment of trauma. From this analysis, there is a description of four functions of art-making in CISD with this population: (a) to increase comfort and emotional safety, (b) to promote expression of thoughts and feelings, (c) to enhance appropriate containment of emotion, and (d) to support ego-strengths. The primary contribution of this research is to offer a clear articulation of the rationale for the consistent use of art-making in CISD with children and youth, and to do so in a way that makes this option available for all debriefers, not just those who are trained as art therapists.

Adolescent↗
PubMed1986

Consequences of worksite hypertension screening. Differential changes in psychosocial function.

To evaluate reports of psychosocial dysfunction after worksite screening, a three-stage blood pressure screening was performed using standardized screening and labeling procedures. Of a heterogeneous group of 5,888 workers, 296 with sustained hypertension were identified and randomly assigned to traditional arousal or reassurance debriefings, matching each hypertensive subject with one to three normotensive control subjects on eight sociodemographic and occupational variables. Subjects exhibiting absenteeism increases or persistent hypertension six months after screening were randomly assigned to worksite health education programs or no intervention. After adjustment for values among matched control subjects, previously unaware hypertensive subjects had significant post-screening decreases in anxiety that were significantly associated with specific worksites and with reassurance rather than traditional debriefing (p less than 0.05). The health education program did not significantly affect anxiety, blood pressure, or absenteeism. Increased absenteeism was associated with higher baseline anxiety levels (p less than 0.05). It is concluded that worksite hypertension screening produces minimal adverse psychosocial changes, reassurance debriefing may be beneficial, and unspecified worksite characteristics may determine consequences of similar preventive medicine efforts.

Absenteeism↗
PubMed2004

A multidisciplinary approach to teach responses to weapons of mass destruction and terrorism using combined simulation modalities.

STUDY OBJECTIVE: To reinforce concepts presented in the lectures; understand the complexity and speed of casualty and information generation during a Weapons of Mass Destruction and Terrorism (WMD/T) event; experience the novelty of combined weapons' effects; recognize the time course of the various chemical, biological, and radiation agents; and make challenging decisions with incomplete and conflicting information. SETTINGS: Two environments simulated simultaneously: one a major trauma center emergency room (ER) with two patient simulators and several human actors; the other an Emergency Operations Command Center (EOC). TARGET AUDIENCE: Students for this course included: clinicians, scientists, military and intelligence officers, lawyers, administrators, and logistic personnel whose jobs involve planning and executing emergency response plans to WMD/T. SIMULATION SCRIPT: A WMD/T attack in Washington, D.C., has occurred. Clinical students performed in their real life roles in the simulated ER, while nonclinical students did the same in the simulated EOC. Six ER casualties with combined WMD/T injuries were presented and treated over 40 minutes. In the EOC, each person was given his or her role title with identification tag. The EOC scenario took cues from the action in the ER via two television (TV) news feeds and telephone calls from other Emergency Operations Assets. PERFORMANCE EXPECTATIONS: Students were expected to actively engage in their roles. Student performances were self-evaluated during the debriefing. DEBRIEFING: The two groups were reunited and debriefed utilizing disaster crisis resource management tools. ASSESSMENT OF EFFECTIVENESS: Students answered an 18-point questionnaire to help evaluate the usefulness and acceptance of multimodality patient simulation. LESSONS LEARNED: Large-scale multimodality patient simulation can be used to train both clinicians and nonclinicians for future events of WMD/T. Students accepted the simulation experience and thought that scenario was appropriately realistic, complex, and overwhelming. Difficulties include the extensive man-hours involved in designing and presenting the live simulations. EOC-only sessions could be staged with only a few video cassette recorders, TVs, telephones, and callers.

Disasters↗
PubMed2006

Training lay-people to use automatic external defibrillators: are all of their needs being met?

AIMS: We explored the experiences of lay people who have been trained to use automatic external defibrillators. The research questions were: (1) How can training courses help prepare people for dealing with real life situations? (2) Who is ultimately responsible for providing critical incident debriefing and how should this be organised? (3) What is the best process for providing feedback to those who have used an AED? METHODOLOGY: Fifty-three semi-structured, qualitative interviews were conducted, some with those who had been trained and others with trainers. Locations included airports, railway stations, private companies and first responder schemes. Geographically, we covered Nottinghamshire, Lincolnshire, Yorkshire, Staffordshire, Essex and the West Midlands in the UK. RESULTS: Our analysis of the data indicates that most people believe scenarios based within their place of work were most useful in preparing for 'real life'. Many people had not received critical incident debriefing after using an AED. There were a variety of systems in place to provide support after an incident, many of which were informal. CONCLUSION: Training scenarios should be conducted outside the classroom. There should be more focus on critical incident debriefing during training and a clear identification of who should provide support after an incident. Other issues which were of interest included: (1) people's views on do not attempt resuscitation (DNAR); (2) perceived boundaries of responsibility when using an AED; (3) when is someone no longer 'qualified' to use an AED?

Attitude↗