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Children's understanding of their research rights before and after debriefing: informed assent, confidentiality, and stopping participation.

This study explored children's understanding of their research rights in the context of an investigation of how children cope with peer provocation. Participants were 178 children (97 girls and 81 boys) who had finished the second, fourth, and sixth grades (average ages: 8, 10, and 12, respectively). After children agreed to take part in research on "how kids get along together," as well as after debriefing, their perceptions of free assent, their understanding of what they would be doing and why, their belief in voluntary participation and freedom to withdraw, and their comprehension of confidentiality were assessed. The vast majority of participants gave assent freely and reported no undue pressure from their families or the experimenters to participate. Older children knew before participating in the research what their participation would involve, comprehended confidentiality, and understood the study's purpose after their participation, but second graders were less likely to understand these issues than fourth and sixth graders were. Following debriefing, children's understanding of their research rights was largely unchanged; most children still had difficulty describing the research goals.

Age Factors↗

Debriefing the family: is research an intervention?

The primary focus of this article is to examine the general assumption that families are left largely unchanged by their participation in research, and to question whether family research can have unintended positive or negative effects on participants. The present article reports feedback from families participating in the Nonshared Environment and Adolescent Development project, a longitudinal study of family process and adolescent development. Families differed in their perceptions about whether the research experience was positive, detrimental, or inconsequential. This feedback underscores the researcher's ethical responsibility to detect and remove deleterious effects of participation. Suggestions are made for providing adequate debriefing to subjects and for using debriefing as a research tool to study the interaction between researcher and families.

Adolescent↗

Critical incident stress debriefing in international aid workers.

Missionaries are well known to suffer the effects of stress. Patricia Miersma relates missionary stress to combat related stress. 1 Development workers too are known to be at increased risk of death whilst overseas-mostly due to traumatic incidents. Relief workers voluntarily enter high stress situations. These overseas workers are at real risk of Post Traumatic Stress Disorder (PTSD). The issue of Critical Incident Stress Debriefing (CISD, or Psychological Debriefing) has been critically examined in an editorial in the British Medical Journal.3 The first randomized, controlled study of CISD that we are aware of (for motor vehicle accident survivors) was published in 1996.4 With 54 intervention subjects, it did not demonstrate effectiveness.

Counseling↗

Critical incident stress debriefing: a health promotion model for workplace violence.

PURPOSE: To view the global impact of violence as a critical incident. DATA SOURCES: Published literature, author's experience. CONCLUSIONS: Psychiatric nurses can use the critical incident stress debriefing protocol to minimize adverse outcomes after a traumatic event. Workplace violence threatens the safety and well-being of nurses. Psychiatric nurses are more likely to encounter workplace violence than nurses in other settings and must prepare themselves using proactive health-promoting activities, for example the critical incident stress debriefing (CISD) model. This health-promotion model provides immediate emotional support and education about normal stress reactions, and may reduce the risk of chronic and disabling emotional and physical consequences.

Crisis Intervention↗

Critical incident stress debriefing following the terrorist bombing at Army Headquarters Northern Ireland.

On the 7 October 1996 the Provisional Irish Republican Army launched a terrorist attack within Northern Ireland. This paper provides a descriptive reflective account of the psychological support and Critical Incident Stress Debriefings (CISD) provided for civilian/military personnel and service families. Between 66 hours and 96 hours following the incident, 407 people were debriefed.

Crisis Intervention↗

Postdisaster psychosocial intervention: a field study of the impact of debriefing on psychological distress.

OBJECTIVE: Following a catastrophic natural disaster, the authors evaluated whether brief psychological intervention (debriefing 6 months later) reduced disaster-related psychological distress as measured by the Impact of Event Scale. METHOD: Two groups of subjects who had been exposed to Hurricane Iniki in Hawaii were assessed before and after participating in a multihour debriefing group. The intervention aimed to provide ventilation of feelings, normalization of responses, and education about normal psychological reactions to the disaster in a context of group support. To provide a partial control for the passage of time, the pretreatment assessment of the second group was concurrent with the posttreatment assessment of the first group. RESULTS: A repeated measures analysis of variance indicated that Impact of Event Scale scores were reduced in both groups after the treatment. CONCLUSIONS: There is preliminary empirical support for the effectiveness of postdisaster psychological intervention and for the feasibility of treatment research in postdisaster environments.

Adult↗

Incorporating psychological debriefing techniques within a brief group psychotherapy programme for the treatment of post-traumatic stress disorder.

BACKGROUND: The Royal Air Force Wroughton Post-Traumatic Stress Disorder (PTSD) Rehabilitation Programme is described. It comprised a 12-day structured in-patient 'course' of group psychotherapy and day-case group follow-up sessions over a one-year period. Psychological debriefing was the main therapeutic technique employed. METHOD: This is a 'before and after' open outcome study. A comprehensive assessment protocol confirmed the presence and severity of PTSD and measured co-morbid psychopathological status, occupational and social function longitudinally. RESULTS: A highly significant global response to treatment is demonstrated in the 34 subjects included in the study, with 85.3% not fulfilling the DSM-III-R criteria for PTSD at one year after treatment. CONCLUSIONS: Further controlled studies assessing the value of psychological debriefing techniques in the treatment of established PTSD are required.

Adaptation, Psychological↗

Screen-based anesthesia simulation with debriefing improves performance in a mannequin-based anesthesia simulator.

BACKGROUND: Previous investigations have established the need for improved training for management of anesthetic emergencies. Training with inexpensive screen-based anesthesia simulators may prove to be helpful. PURPOSES: We measured the effectiveness of screen-based simulator training with debriefing on the response to simulated anesthetic critical incidents. METHODS: Thirty-one 1st-year clinical anesthesia residents were randomized into 2 groups. The intervention group handled 10 anesthetic emergencies using the screen-based anesthesia simulator program and received written feedback on their management, whereas the traditional (control) group was asked to study a handout covering the same 10 emergencies. All residents then were evaluated on their management of 4 standardized scenarios in a mannequin-based simulator using a quantitative scoring system. RESULTS: The average point score for the simulator-with-debriefing group was 52.6 +/- 9.9 out of 95 possible points. The traditional group average point score was 43.4 +/- 5.9, p = .004. CONCLUSIONS: Residents who managed anesthetic problems using a screen-based anesthesia simulator handled the emergencies in a mannequin-based anesthesia simulator better than residents who were asked to study a handout covering the same problems. Computer simulations with feedback are effective as a supplement to traditional residency training methods for the management of medical emergencies.

Anesthesiology↗

Preventing psychological trauma in soldiers: the role of operational stress training and psychological debriefing.

Armed conflict is associated with significant long-term psychiatric morbidity. Interventions to reduce the incidence of psychiatric disorder following psychological trauma may be classified into three categories. Primary prevention includes the selection, preparation and training of individuals likely to be exposed to potentially traumatizing events. Secondary prevention comprises a variety of brief psychological techniques immediately or shortly after traumatizing life events, the best known of which is Psychological Debriefing. Tertiary interventions comprise the treatment of established PTSD and others. Psychiatric morbidity was studied in 106 British soldiers returning from UN peace-keeping duties in the former Republic of Yugoslavia. All 106 soldiers received an Operational Stress Training Package prior to their deployment and a randomly selected group also received a post-operational PD. Very low rates of PTSD and other psychopathology were found overall and the Operational Stress Training Package may have contributed to this. Elevated CAGE scores suggestive of significant alcohol misuse were observed in both groups and chemical avoidance behaviours arising from this may have masked psychopathology. CAGE scores diminished significantly in the debriefed group by the end of the follow-up period suggesting that PD may have been of benefit despite the apparent absence of PTSD. This study also demonstrates that a high incidence of psychiatric morbidity is not an inevitable consequence of military conflict.

Adolescent↗

Elements of critical incident debriefing.

The present paper lists a number of specific therapeutic steps involved in critical incident debriefing. These therapeutic suggestions, while by no means exhaustive, include (a) identification, (b) labeling, (c) articulation, (d) expression, (e) externalization, (f) ventilation, (g) validation, and (h) acceptance. More careful attention to these specific elements--regardless of debriefers' training and backgrounds--might improve therapeutic consistency for trauma victims afflicted with stress-related symptoms. Further applications of these therapeutic steps were also suggested for other types of behavioral problems.

Adaptation, Psychological↗

Psychiatric stress debriefing. Alleviating the impact of patient suicide and assault.

Psychiatrists and psychologists have developed the psychological autopsy into a debriefing tool, as well as a learning tool. Use of the CISD has been an effective protocol to help police, fire, ambulance, emergency room, and ICU personnel cope with the effects of violence and trauma. Psychiatric nurses and ancillary personnel also face frequent exposure to violence and trauma. The psychiatric debriefing protocol offers a practical intervention.

Adaptation, Psychological↗

Critical incident stress debriefing: clinical applications and new directions.

Critical Incident Stress Debriefing (CISD) was originally developed as a short-term, group-format, preventive mental health intervention for traumatized law enforcement and emergency services personnel. The debriefing model has since been applied to a variety of clinical groups and crisis situations, correspondingly undergoing modifications in its structure and process. This review describes the CISD approach and explores some of the new directions being taken by practitioners of this intervention strategy. In addition, this review addresses some of the recent critiques of the CISD model, and makes recommendations for optimal utilization of this clinical tool with those populations most likely to benefit from it.

Crisis Intervention↗

A debriefing approach to dealing with the stress of CPR attempts.

Nurses may suffer physiological and psychological stress following a cardiopulmonary resuscitation attempt. Implementation of debriefing sessions following the care of a patient experiencing a cardiac arrest can reduce staff stress. Using a debriefing process enables learning opportunities to be identified and acted on by resuscitation teams.

Burnout, Professional↗

Critical incident stress debriefing (CISD): its role in the Armed Services--a personal opinion.

The controlled application of CISD in the Armed Services is of value. In a varied Army career covering service with both regular and specialist units, there are instances where in retrospect the opportunity to discuss an incident in a CISD environment or the receipt of a general health warning would have been welcomed and assisted the group (or the individual) concerned to return to operational effectiveness. Practical considerations aside a colleague and friend who has been closely involved with CISD in the Forces since its inception, cites a very good case for its defence. In the early 1990s, as part of a small team, he conducted a large number of emotionally charged debriefs with soldiers recently returned from an operational tour in Bosnia. Returning 2 years later he questioned them as to whether they thought the debriefs worthwhile. There was a mixed response but the most telling came from a hard-bitten individual who stated that regardless of the benefits at least it showed that the system cared. I can think of no better reason to support CISD and encourage its development.

Crisis Intervention↗

Critical incident stress debriefing: a family nursing intervention.

Critical Incident Stress Debriefing is an intervention that assists patients and families to master the stresses resulting from being a witness to or victim of violent acts. Intervening at the level of the family system, the clinical nurse specialist can facilitate communication, decrease anxiety, and provide education regarding the post-trauma response.

Adult↗

Debriefing: its evolution and current status.

Debriefing, like trauma counseling, and even grief counseling, has been taken up as an instant solution. Some suggest it is a part of the trauma industry. It may be seen as something to hold onto in the face of disaster or other chaos, because it offers the security of a structure, some sense of control over what to do to help when one wishes to undo what has happened, help others and the self, to make meaning of a horrific or shocking experience. The need to pursue a way of responding suggests that those who would offer help fear being overwhelmed, or do not trust their normal compassionate, protecting, and comforting responses. It would be sad if these spontaneous, caring, and altruistic reactions that so bind human society in times of tragedy were devalued or put aside, for they, ultimately are the beginning of the healing process.

Adaptation, Psychological↗

Critical incident stress debriefing: implications for best practice.

Critical incidents disrupt people's lives by creating strong emotional reactions, which may range from normal stress reactions to post-traumatic stress disorders. Critical incident stress debriefing (CISD) has been used since 1983 as a component of Critical Incident Stress Management. The processes are intended to help individuals manage their normal stress reactions to abnormal events. Although used extensively, research findings to date yield mixed results. Meta-analyses of research studies are reviewed to identify the methods, results, strengths, and weaknesses of the studies that can be used for evidence-based practice.

Crisis Intervention↗