Digital Repository Masters Projects Spring 2025 Clinical Debriefing After an Unexpected Patient Death Amy Crosland Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Crosland, A. 2025. Clinical Debriefing After an Unexpected Patient Death Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. WSU REPOSITORY MSN/DNP Clinical Debriefing After an Unexpected Patient Death Project Title by Amy Crosland Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY April 26, 2025 Ogden, UT Date Amy Crosland BSN, RN, MSN Student April 26, 2025 Student Name, Credentials (electronic signature) Date Trish Gibbs DNP, RN, CNE April 26, 2025 MSN Project Faculty Date (electronic signature) Anne Kendrick, DNP, RN, CNE (electronic signature) DNP, N, CNE MSN Program Director Note: The program director must submit this form and paper. April 26, 2025 Date 1 Debriefing After an Unexpected Patient Death Amy Crosland, BSN, RN, MSN Student Annie Taylor Dee School of Nursing Weber State University MSN Project 2 Abstract Purposes/Aims: The purpose of this quality improvement project is to establish a standardized debriefing program in the Intensive Care Unit at Holy Cross Davis Hospital. The aim of implementation is to decrease the moral distress often felt among healthcare workers after a patient dies unexpectedly. Rationale/Background: Lack of debriefing after a patient's death can lead to nurses experiencing moral distress, burnout, and symptoms of Post Traumatic Stress Disorder. Recent literature supports the implementation of standardized debriefing to assist nurses in achieving greater emotional and mental well-being and improving patient outcomes. Methods: Using the evidence obtained from the literature review, a plan was devised to implement standardized debriefing. The nursing staff will complete pre- and post-intervention surveys to evaluate effectiveness. Consent will be obtained from the nursing staff before implementation, and the surveys will be submitted anonymously. The Iowa Framework Model will structure the project and aid in frequent reevaluation. Results: Nursing staff reported experiencing less moral distress, guilt, and symptoms of burnout. Collaboration among the nursing staff improved through enhanced communication. Feedback was provided during debriefings to offer education on improving future patient outcomes and safety. Conclusions: Debriefing supports nursing staff during times of guilt, anger, and sadness. It provides an opportunity to voice concerns, receive feedback, and feel supported by colleagues. This relatively low-cost and easy-to-implement intervention can be utilized in hospitals worldwide. Keywords: debriefing, burnout, moral distress, death, intensive care 3 Debriefing After an Unexpected Patient Death When a patient in the Intensive Care Unit dies unexpectedly, healthcare workers can be plagued with questions. They may wonder if they missed something or should have done anything different to keep the patient alive. They may struggle with fear, doubt, anger, and even self-blame. Nurses who carry these emotions forward without closure or effective coping often report long-term feelings of burnout and Post Traumatic Stress Disorder (PTSD) (Delany et al., 2021). Debriefing is a tool that the military and first responders have utilized since WWII (Toews et al., 2021). Following a critical incident or stressful situation, debriefing is a time to step away from the incident and discuss the event with multidisciplinary team members (Delany et al., 2021). Structured debriefing sessions are a safe and effective way to provide healthcare providers with much-needed feedback and reassurance, while also identifying opportunities for improvement (Beres et al., 2022). As healthcare workers improve their wellbeing and resilience, strengthen relationships with other interdisciplinary team members, and identify gaps in knowledge or skills, patients will ultimately benefit. Statement of Problem Nurses frequently confront death. Following the death of a patient, healthcare providers have reported experiencing emotions such as sadness, anger, and even guilt (Berchtenbreiter et al., 2024). Providers doubt themselves and the care they have given, wondering if they could have done something differently (Harder et al., 2020). Unfortunately, their emotional well-being after these traumatic events is frequently neglected, leading to potential long-term issues such as PTSD and burnout (Evans et al., 2023). This is a widespread issue nurses worldwide face (Sandoval et al., 2023). The purpose of this MSN project is to implement a structured debriefing tool for use in the ICU after a patient's unexpected or traumatic death. This goal will be achieved by reviewing the current literature to determine the extent of the problem and identify the best practices for critical incident stress debriefing in the 4 ICU. A structured debriefing program (including who, what, when, and where) will then be formulated for implementation in the Holy Cross Davis Hospital ICU. Significance of the Project Nurses are leaving the profession they love, often because of burnout. Critical care nurses report feeling burned out when they must push through traumatic situations. When left to deal with the effects of these critical incidents, these situations can have a profound impact on staff mental health (Harder et al., 2020). Following an unexpected patient death, nurses report feeling guilty, angry, inadequate, and frustrated, as well as physical symptoms of PTSD (Berchtenbreiter et al., 2024). These situations are not isolated incidents but happen in hospitals worldwide (Sandoval et al., 2023). When a nurse is involved in these situations, they may exhibit symptoms of PTSD (Berchtenbreiter et al., 2024). Following the loss of a patient, debriefing has been shown to reduce long-term feelings associated with burnout and PTSD (Delany et al., 2021). Debriefing allows staff members to step away from the situation momentarily and express their emotions about what has transpired, while feeling supported and reassured by their colleagues (Berchtenbreiter et al., 2024). Patient outcomes improve with debriefing (Towes et al., 2021). As debriefing occurs, interdisciplinary team members strengthen relationships, increase trust, and enhance communication (Bolte et al., 2024), which in turn leads to improved patient outcomes (Toews et al., 2021). Healthcare workers may utilize debriefing as an opportunity for reflection and education (Berchtenbreiter et al., 2024). During debriefing, the focus can be placed on processes and the quality of resuscitation (Bolte et al., 2024). As a code team, knowledge can be gained through constructive feedback that explains the rationale behind clinical decisions (Toews et al., 2021). Through reflection and feedback, areas for improvement can be identified and incorporated into future endeavors (Edwards et al., 2020). Many studies have addressed debriefing, and various tools are available. The evidence suggests that a structured debriefing process is beneficial (Berchtenbreiter et al., 2024). Using a structured process supported by administrators indicates that the well-being of staff is vital to the company. When supervisors were involved 5 in debriefing, healthcare workers reported feeling better supported and experienced fewer symptoms of compassion fatigue and burnout (Richins et al., 2020). A structured and mandatory debriefing program benefits nurses who may not have sought support previously (Beres et al., 2022). Increased health and well-being of staff engaged in regular debriefings have been reported (Harder et al., 2020). Critical incident debriefing improves communication among healthcare providers. Through constructive feedback, education can be provided to aid in improving patient outcomes. Review of the Literature This literature review aims to explore current evidence on the influence of clinical debriefing following the unexpected loss of a patient. In nurses taking care of patients who die (P), how does debriefing (I) after the patient’s death compare to no debriefing (C) impact nurses’ ability to process the event (O)? The evidence will support and guide the planning and implementation of a debriefing process in the ICU. Currently, there is no process of debriefing following the death of a patient, and nurses are left to deal with their emotions and frustrations alone. Framework The Iowa Model is widely used and comprises seven phases. Step one identifies the opportunity for change. The need for a more effective way to debrief has been identified. Step two defines the purpose. The purpose of this project is to improve the well-being of nurses involved in the traumatic or unexpected death of a patient. Step three forms a team. A team of stakeholders will be organized using current management, house supervisors, and charge nurses. Step four gathers and analyzes information. Data will be collected using an anonymous survey of current practice and well-being among critical care registered nurses. A literature review will also identify the current best practices for debriefing. Analysis of both the pre-survey and the literature will be completed. Step five designs the debriefing tool and plans its implementation. The logistics will be planned to include questions and formatting of the debriefing session and follow-up. Step six involves integrating and sustaining the new practice. The debriefing tool will go live, and evaluation will be performed after ten 6 debriefing sessions via a post-intervention survey. Post-survey results will then be evaluated and analyzed. In step seven, the findings will be disseminated. If the debriefing plan is effective, it can be shared with other units in the hospital and beyond (Cullen et al., 2022). Duff et al. (2020) describe one of the key reasons for this model’s success: It emphasizes the collaboration of a multidisciplinary team in step three. This step is imperative since critical care nurses will not be the only clinicians impacted by implementing standardized debriefing. When a code is called, healthcare providers from other hospital areas, physicians, respiratory therapists, and sometimes pharmacists respond. The need to debrief does not solely belong to the nursing staff. The Iowa model also endorses projects to be led by frontline staff (Duff et al., 2020). When projects are something that the nursing staff are interested in, they are more likely to be successful than when something is imposed on them by nurse leaders and management (Cullen et al., 2022). Strengths and Limitations The Iowa Model utilizes frontline nurses as leaders (Cullen et al., 2022). As nurses at the front line, they are more keenly aware of processes, workflow, and opportunities for change or improvement. Nurses want to support their coworkers; thus, buy-in is easier to achieve when a peer is the leader of the change. Staff nurses also participate in shared governance, which utilizes committees, collaboration, and evidence-based ideas for change (Duff et al., 2020). As with most frameworks, support from organizational leaders is vital (Duff et al., 2020). While many frontline healthcare providers can identify the need for change, this framework cannot be effective without the support of nurse managers and administration. Because the Iowa Framework Model emphasizes being driven by nursing staff, support from staff is vital. If nurses are not interested in invoking change and working through the framework, the model cannot be successful (Chiwaula & Jere, 2022). There is more to making a change than just identifying a problem. The Iowa model will not yield the intended results without a supportive culture, 7 effective communication, adequate resources, comprehensive education, and data-driven evaluation (Duff et al., 2020). Analysis of Literature Debriefing is a tool that has been utilized to support military personnel, police officers, firefighters, and first responders (Toews et al., 2021). Few studies have been conducted to show its effectiveness in critical care nursing (Berchtenbreiter et al., 2024). The debriefing process enables nurses and other healthcare providers to process their emotions, analyze what happened, feel supported by their coworkers and leaders, and receive constructive feedback. This literature review examines the current research on debriefing for critical care nurses following an unexpected or traumatic situation. These studies support the use of debriefing to combat burnout and compassion fatigue among critical care nurses. Search Strategies A literature search was conducted using Google Scholar, Weber State University’s Stewart Library Advanced Search, PubMed, ResearchGate, National Center for Biotechnical Information, EBSCO, and Science Direct to identify the current evidence. Only articles from 2019 through 2024 were included to provide the most current evidence. The search included keywords such as patient death, debriefing, nurse debriefing, critical incident, nurse well-being, intensive care unit (ICU), dying, compassion fatigue, burnout, and secondary traumatic stress. Various Boolean combinations were created with the above-mentioned keywords to create a broad search. Synthesis of the Literature Three themes were identified during this literature review. The first theme identified is the benefits that debriefing can give to nurses' well-being and emotional health. The second theme highlights the benefits of debriefing in improving patient outcomes. The third theme identifies and describes key attributes of a successful debriefing. Debriefing Positively Influences Nurses' Well-Being 8 The current literature supports that structured debriefing following the death of a patient can positively influence a nurse's well-being (Berchtenbreiter et al., 2024; Beres et al., 2022; Harder et al., 2019; Holbert & Dellasega, 2021). Caring for a critically ill patient affects a nurse's mental, physical, and emotional well-being (Beres et al., 2022). If a nurse does not have adequate coping strategies or feels unsupported, the nurse may experience a prolonged stress response, which may result in long-term physical and emotional issues (Harder et al., 2019). When healthcare workers are taught how to debrief effectively, they experience decreased stress, burnout, and compassion fatigue (Holbert & Dellasega, 2021). Debriefs provide an opportunity for coworkers to give and receive support, ensuring everyone is equipped to move forward (Berchtenbreiter et al., 2024). Nurses report that participating in debriefing can validate and normalize their feelings (Holbert & Dellasega, 2021). When nurses feel supported and cared for, they provide better patient care (Beres et al., 2022). Nurses who participated in debriefing described an increase in their ability to cope with stress and grief (Holbert & Dellasega, 2021). When debriefing occurs regularly, healthcare workers are taught appropriate coping strategies and experience less guilt and self-blame (Berchtenbreiter et al., 2024). An increased sense of belonging was observed following debriefing, accompanied by a decrease in emotions related to feelings of isolation and loneliness (Harder et al., 2019). Improving Patient Outcomes Through debriefing, collaboration and communication among team members improve, leading to increased safety and better patient outcomes (Bolte et al., 2024; Gilmartin et al., 2020; Lyman, 2021; Paquay et al., 2021; Przednowek et al., 2021). Debriefing has also been utilized as a means of educating and providing feedback to healthcare professionals, resulting in improved patient care (Berchtenbreiter et al., 2024; Toews et al., 2021). Debriefings have been successfully shown to improve healthcare workers' emotional resilience, and healthcare workers generally prefer to debrief with individuals who have faced similar situations (Przednowek 9 et al., 2021). Additionally, debriefing serves as a time for interdisciplinary team members to reflect, identify errors, and discuss areas for improvement (Lyman, 2021). Evidence suggests a direct link between postresuscitation debriefings and improved communication and collaboration among healthcare workers (Bolte et al., 2024; Gilmartin et al., 2020; Paquay et al., 2021). Furthermore, the increased frequency of debriefings has been shown to improve trustworthy relationships among team members (Lyman, 2021). As teamwork increases through clinical debriefing, patient safety will also improve. Paquay et al. (2021) report that their study found a correlation between debriefing and an increase in incident reports. They perceived that the culture had shifted and that healthcare workers had become more aware of issues regarding patient safety, as situations were discussed during debriefing (Paquay et al., 2021). Debriefing provides an opportunity for education and constructive feedback (Paquay et al., 2021). As situations are discussed, clarity can be gained as a rationale for decision-making is examined (Toews et al., 2021). Berchtenbreiter et al. (2024) found that debriefing was an excellent opportunity to discuss education needs in real-time. The information gained through debriefing improves patient outcomes in succeeding critical events (Toews et al., 2021). Key Attributes to Successful Debriefing The literature agrees that a structured debriefing session is needed, focusing on several critical attributes for best functionality (Delaney et al., 2023; Richins et al., 2020; Sandoval et al., 2023; Toews et al., 2021). Sandoval et al. (2023) endorse that the chosen debriefing tool be used to “mitigate the impact of the sentinel event, facilitate normal recovery processes and restoration of adaptive functions in psychology, and identify group members who may benefit from additional supportive resources or referral to Employee Assistance Programs (EAP)” (p. 580). Toews et al. (2021) organized their findings into the five Es: educated/experienced facilitator, environment, education, evaluation, and emotions. While Toews et al. (2021) valued using a skilled facilitator, Paquay et al. (2023) found it to be more effective when led by a staff nurse. Studies have agreed that whoever 10 leads the debriefing should undergo some training and that the debriefing process should be supported by management (Toews et al., 2021; Paquay et al., 2023; Richins et al., 2020; Sandoval et al., 2023). The environment plays a vital role in the effectiveness of debriefing (Toews et al., 2021). Berchtenbreiter et al. (2024) found that nurses preferred “hot debriefing,” which occurred immediately after the incident or very shortly after. Toews et al. (2021) found that it was vital for the staff to step off the unit to receive support and regroup. Stepping away from the incident creates a safe space for staff to receive feedback in a respectful and constructive manner (Delaney et al., 2023). In contrast, “cold debriefing” occurs later, maybe even days later. The decision to conduct a hot or cold debrief depends on the situation, convenience, the individuals involved, and other clinical obligations (Edwards et al., 2021). Summary of Literature Review Findings and Application to the Project Debriefing has had a positive impact on nurses, other healthcare workers, and patients (Holbert & Dellasega, 2021). When debriefing occurs routinely, nurses may exhibit fewer symptoms of stress and burnout (Berchtenbrieter et al., 2024). Frequent debriefing increases cohesiveness and communication among interdisciplinary team members (Lyman, 2021). Through collaboration and education, patients will be safer and experience better outcomes. Debriefings should be led by someone who has undergone training in an environment that best suits the situation and needs of the staff (Toews et al., 2021). These findings apply to the project of implementing a formalized debriefing tool to be used after nurses are involved in the traumatic or unexpected death of a patient. The literature supports the use of debriefing in assisting with the mental health and emotional well-being of nurses in the ICU. The following project will use the evidence found to guide the planning and implementation of a structured debriefing program in the ICU. Project Plan and Implementation Holy Cross Davis is a small community hospital. The ICU has 14 beds, 23 registered nurses, and five nursing assistants. Much of the literature focuses on larger units with more nursing staff. Implementing debriefing at Holy Cross Davis may prove challenging, but the effort required to execute it will benefit the staff 11 and reduce burnout. An interdisciplinary team will be assembled, the literature will be presented, and barriers will be discussed. Staff will be educated about the new standardized debriefing, and charge nurses and house supervisors will be given training on how to facilitate debriefings. After the debriefing has been initiated, a follow-up evaluation will occur. Plan and Implementation Process The first step in implementing this change is to receive support from the ICU manager, director, and chief nursing officer (Duff et al., 2020). The information will be presented to these members of the hospital administration. At this time, they may ask questions and voice any concerns. Receiving support from hospital administration shows nursing staff that their well-being matters (Richins et al., 2020). A task force comprised of volunteer stakeholders will be assembled. Proposed stakeholders include bedside nursing staff, house supervisors, charge nurses, and hospital administration. The debriefing task force will distribute a brief survey to all nursing staff. This survey will be completed anonymously and reflect the staff's current feelings about support after death and burnout and how they feel they could best be assisted. The results will be collected, reviewed, and compared with the post-implementation survey. The task force will discuss the literature review and the results of the pre-implementation survey, as well as formulate the best approach to implementing standard debriefing. The task force will develop the debriefing structure and the questions or topics to be discussed during the debriefing. It is proposed that the debriefing be structured (Beres et al., 2022) and led by a trained facilitator (Toews et al., 2021; Paquay et al., 2023; Richins et al., 2020; Sandoval et al., 2023). ICU charge nurses and house supervisors will attend facilitator training. While “hot” debriefing has been successful (Berchtenbreiter et al., 2024), debriefing cannot happen immediately after the event at Holy Cross Davis. Due to staffing constraints, debriefing will occur at the end of the shift. Berchtenbreiter et al. (2024) still considers this to be a hot debriefing. The debriefing will occur in the breakroom, where staff can step away from patients and their families to express themselves freely (Toews et al., 2021; Delaney et al., 2023). 12 Once the details are in place, the unit charge nurses and house supervisors will be trained. The training will include how to facilitate debriefing, the importance of providing emotional support to staff members (Holbert & Dellasega, 2021), and what to do if someone needs more assistance than can be obtained during debriefing (Sandoval et al., 2023). After completing the training, the process will be presented at a staff meeting. Debriefings will be held at a minimum after an unexpected patient death but may also be held at the facilitator's discretion. After ten debriefing sessions, the nursing staff will receive another anonymous survey, the same as the pre-implementation survey. The task force will meet again to compare the post-survey results with the pre-implementation survey. Interdisciplinary Team Nursing staff, including nursing assistants, will benefit from debriefing as they are supported by management and coworkers. They will be given time to discuss their feelings and frustrations and seek additional help as needed. Nursing staff will be supported by other team members, leading to increased teamwork, communication, and emotional well-being (Bolte et al., 2024; Gilmartin et al., 2020; Lyman, 2021; Paquay et al., 2021; Przednowek et al., 2021). Patient outcomes will improve by increasing teamwork, communication, and emotional resiliency among nursing staff. During debriefing, nurses can receive real-time feedback and discuss opportunities for improvement (Paquay et al., 2021; Toews et al., 2021). Patient outcomes improve as teamwork and emotional well-being increase among nursing staff, alongside knowledge and skills. Improved patient outcomes benefit healthcare workers, hospital administration, and, most importantly, patients and their families. When nurses exhibit high levels of well-being, they are less likely to experience symptoms of burnout and seek alternative employment (Delany et al., 2021). A decrease in nurse turnover is better for patients and hospital staff (Harder et al., 2020). Description and Development of Project Deliverables 13 The information will be shared with the ICU nursing staff and displayed on an educational poster throughout the unit, near the time clock, and in the house supervisor’s office (see Appendix A). The poster is designed to inform the nursing staff about establishing the task force, which will work together to implement the debriefing plan. The goal of forming a task force is to demonstrate to staff that the administration supports them and to empower staff nurses to take ownership of their unit (Beres et al., 2022; Richins et al., 2020). An educational PowerPoint presentation (see Appendix B) will be conducted for the ICU nursing staff to update them on the forthcoming changes to the process. Their support is crucial for successfully implementing the debriefing plan (Toews et al., 2021). The presentation will discuss the current problems and the steps that will be taken to address them. Following the PowerPoint presentation, the nursing staff will be given a pre-implementation survey (see Appendix C). This same survey will be used for both the pre-implementation and post-implementation phases. Providing open and honest responses is vital; therefore, survey submissions will remain confidential (Berchtenbreiter et al., 2024; Paquay et al., 2023; Sandoval et al., 2023). Timeline The proposed timeline (see Appendix D) for implementing this debriefing project is as follows: On January 22, posters will be distributed in designated areas to invite volunteers to join a task force. These posters will be displayed in high-traffic locations to reach as many individuals as possible. The meeting with the task force is scheduled for one week later, on January 29. During the meeting, we will discuss the current problem (not debriefing), its impact on healthcare workers, the proposed project, and assessment tools. Together, we will create an outline for the debriefing, highlighting the questions to discuss. Tasks will be delegated, including preparing and distributing surveys, analyzing collected data, and comparing pre- and postimplementation. A representative from the task force will attend the ICU charge nurse meeting on January 30. During this time, leaders will receive education through a PowerPoint presentation and will be trained to conduct 14 effective debriefings. A literature review of current evidence supporting debriefing will also be provided. This information will then be shared with the rest of the ICU staff on February 11 during their staff meeting. The pre-implementation survey will be distributed and collected for evaluation following the presentation. The surveys collected will be analyzed during a meeting on February 14 in preparation for implementing debriefing on February 16. Another charge nurse meeting for the ICU is scheduled for March 4. At this meeting, charge nurses will have the chance to share their thoughts on the progress of debriefing and suggest any necessary modifications. If ten debriefings have taken place, a task force member will attend the ICU staff meeting on March 11 to distribute the post-implementation survey and gauge staff's feelings about the debriefing process. The discussion will include what is going well, opportunities for improvement, and general feedback towards the debriefing project. If fewer than ten debriefings have occurred, this will take place at the meeting on April 8. The pre- and post-surveys will be compared after collecting and evaluating the post-implementation survey. The findings will be presented at a task force meeting on March 19. Changes will be made to the current process as necessary. Debriefing will continue in the ICU and will be re-evaluated using the same survey at the July staff meeting and again in February 2026. Staff members will be asked to complete the survey at each meeting. Surveys will be reviewed and analyzed, with modifications being made as needed. A summative evaluation will occur in February 2026. This timeline allows for adjustments to be made as needed. The Iowa model of change promotes this concept of constant re-evaluation. By continually reevaluating and revising, the plan can remain relevant and meet the current needs of the nursing staff in the ICU. Project Evaluation The project's success will be evaluated through pre- and post-implementation surveys. These surveys will be distributed regularly during the project's initial phase: a preliminary survey, a survey after ten debriefings or approximately 1-2 months, one about four months after implementation, and another six months 15 later, followed by subsequent annual surveys. Information collected from these surveys will provide evidence of the nurses' emotional well-being or lack thereof. The Iowa Model for Change supports this approach and encourages frequent evaluation and revision in a loop, rather than a linear progression (Cullen et al., 2022). Evaluation of the surveys and subsequent modifications serves as the formative evaluation. Data regarding the frequency of debriefs and the circumstances surrounding them will also be tracked and assessed. This project will be effective if debriefings are consistently conducted after a patient's death, with support from staff participants (Holbert & Dellasega, 2021). This project will continue to evolve through assessing and modifying as the needs of the unit change and grow. At one-year post-implementation, a meeting will be held with the nursing staff in the ICU to discuss what has been learned from the previous year of participation in standardized debriefing. At that point, the decision will be made whether to continue with standardized debriefing or terminate the project (summative evaluation). Ethical Considerations Nurses often leave bedside care due to burnout and heightened stress (Evans et al., 2023; Sandoval et al., 2023). Being a nurse is a challenging profession, and it is crucial to support nurses during periods of increased stress, sadness, and guilt that may follow a patient's death (Harder et al., 2019). This project aims to enhance positive patient outcomes and social responsibility by supporting nurses during stressful situations and improving their emotional well-being. All nursing staff working in the Holy Cross Davis ICU can participate, regardless of age, sex, race, religion, or position. Survey results will remain anonymous to encourage honest feedback. Due to the anonymity of the completed surveys, participants who choose not to participate will not be identified. The information will be protected, as no personal names are associated with the data collected. Nursing staff will be encouraged to complete surveys by raising awareness of the need for their feedback to inform and implement changes. The problem has been discussed with them, and the potential benefits of participation in this project will also be explained. The benefits of participating in this study include increased teamwork (Lyman, 2021), 16 decreased moral distress (Beres et al., 2022), and improved patient outcomes (Paquay et al., 2023). Informed consent will be received before staff participate in this project. Consent will outline that participation is voluntary and anonymous and will be used to inform changes to current practices. The goal of this project is to decrease moral distress among nursing staff. If participants experience increased distress because of their participation, they will be referred to the Employee Assistance Program (EAP) for additional support. Discussion This debriefing project proposes changes to be implemented in hospitals worldwide. As it is disseminated at the hospital, university, and global levels, the hope is that other hospitals will consider the evidence. This study holds significant importance for many healthcare workers as it aims to reduce moral distress, burnout, and symptoms of PTSD. Additional studies may be conducted, varying the duration of debriefing or the size of the unit. Evidence-based Solutions for Dissemination This project will be showcased to educators and peers at Weber State University as a poster in its initial phases. The current project will also be presented to the hospital senate members at Holy Cross Davis Hospital. Following the summative evaluation, the findings will be compiled into a paper and submitted for publication, allowing other hospitals to learn from the studies conducted at Holy Cross Davis Hospital. Significance to Advance Nursing Practice This project affects nurses worldwide. The loss of a patient is never easy, no matter the circumstances. When a patient dies, nurses often blame themselves and experience feelings of guilt, inadequacy, and sadness (Morley & Horsburgh, 2023). If left untreated, those feelings develop into moral distress, burnout, and even PTSD (Evans et al., 2023). These situations may cause nurses to leave the profession (Harder et al., 2019). By implementing a process that supports nursing staff and provides a safe space for them to discuss their feelings with coworkers who understand their emotions, the well-being of staff will improve (Berchtenbreiter et al., 2024). 17 Patient outcomes improve when nursing staff experience positive emotional well-being (Beres et al., 2022). When debriefing is used to educate and provide feedback, appropriate changes can be made, leading to improved patient safety (Berchtenbreiter et al., 2024; Toews et al., 2021). Debriefing enhances interdisciplinary collaboration and promotes effective communication, ultimately improving safety and patient outcomes (Gilmartin et al., 2020). Implications One strength of this project is the framework utilized to model the plan or debriefing. The Iowa Framework Model promotes regular evaluations, adjustments, and re-evaluations (Cullen et al., 2022). This allows the project to adapt to the needs of the unit and its staff members. Another strength of the project is that it is evidence-based, drawing from current literature that supports debriefing following a patient's death. Current research highlights the effectiveness of debriefing in reducing moral distress among healthcare workers and improving patient outcomes. The most significant limitation of this project is the size of the ICU at Holy Cross Davis Hospital. The small sample size may not prove effective, whereas debriefing at a larger facility may be more successful. Another limiting factor is that, due to the small size of the staff, debriefings are most often held after shift changes. This could impede the support received from staff and decrease their willingness to participate. Despite these limitations, every effort will be made to support the staff participating in this project. If facilitators need more skills, they will be provided with more education. Efforts will be made to hold debriefings as soon as possible following a death; however, they may also be held after the shift change. Debriefing will support and strengthen relationships among coworkers while educating and providing feedback. Increased education for healthcare workers contributes to improved patient outcomes (Sandoval et al., 2023). Supporting and strengthening healthcare workers experiencing moral distress is not only a kind gesture, but it is also a moral obligation to care for those who care for others (Beres et al., 2022). Recommendations 18 For future research, piloting this program at a larger hospital or a larger group of small hospitals is suggested. A comparison of immediate debriefing vs. end-of-shift debriefing would also benefit the study (Berchtenbreiter et al., 2024). More staff resources would be needed to provide “hot” debriefing. The implementation of debriefing is crucial to staff well-being (Paquay et al., 2023). Nursing staff should be supported and their feelings understood to combat the stresses associated with frequent patient deaths (Sandoval et al., 2023). Without support and intervention, more healthcare workers will leave the bedside due to moral distress and PTSD (Berchtenbreiter et al., 2024). Conclusions Evidence suggests that standardized debriefing benefits both healthcare workers and the interdisciplinary team, positively impacting patient outcomes (Bolte et al., 2024). Through the process of debriefing, nursing staff may exhibit fewer symptoms of burnout and PTSD (Berchtenbreiter et al., 2024). Debriefing also increases teamwork and communication (Holbert & Dellasega, 2021). Consistent debriefing provides time for education and constructive feedback (Toews et al., 2023). With the support of the hospital administration, the benefits of debriefing will lead to positive changes in the lives of nurses and patients alike (Beres et al., 2022). 19 References Berchtenbreiter, K., Innes, K., Watterson, J., Nickson, C. P., & Wong, P. (2024). Intensive care unit nurses’ perceptions of debriefing after critical incidents: A qualitative descriptive study. Australian Critical Care, 37(2), 288–294. https://doi.org/10.1016/j.aucc.2023.06.002 Beres, K. E., Zajac, L. M., Mason, H., Krenke, K., & Costa, D. K. (2022). Addressing compassion fatigue in trauma emergency and intensive care settings: A pilot study. Journal of Trauma Nursing, 29(4), 210– 217. https://doi.org/10.1097/jtn.0000000000000663 Bolte, C., Wefer, F., Stulgies, S., Tewesmeier, J., Lohmeier, S., Hachmeister, C., Günther, S., Schumacher, J., Mohemed, K., Rudolph, V., & Krüger, L. (2024). Post-resuscitation talk in the intensive care unit. Medizinische Klinik - Intensivmedizin Und Notfallmedizin, 119(4), 268–276. https://doi.org/10.1007/s00063-024-01129-9 Chiwaula, C. H., & Jere, D. L. (2022). Experiences of nurse managers and practitioners on implementation of an evidence-based practice intervention. Health SA Gesondheid, 27. https://doi.org/10.4102/hsag.v27i0.1597 Cullen, L., Hanrahan, K., Edmonds, S. W., Reisinger, H. S., & Wagner, M. (2022). Iowa implementation for sustainability framework. Implementation science : IS, 17(1), 1. https://doi.org/10.1186/s13012-02101157-5 Delany, C., Jones, S., Sokol, J., Gillam, L., & Prentice, T. (2021). Reflecting before, during, and after the heat of the moment: A review of four approaches for supporting health staff to manage stressful events. Journal of Bioethical Inquiry, 18(4), 573-587. https://doi.org/10.1007/s11673-021-10140-0 Duff, J., Cullen, L., Hanrahan, K., & Steelman, V. (2020). Determinants of an evidence-based practice environment: An interpretive description. Implementation science communications, 1, 85. https://doi.org/10.1186/s43058-020-00070-0 20 Edwards, J. J., Wexner, S., & Nichols, A. (2020). Debriefing for clinical learning. PSNet. https://psnet.ahrq.gov/primer/debriefing-clinical-learning Evans, T. R., Burns, C., Essex, R., Finnerty, G., Hatton, E., Clements, A. J., Breau, G., Quinn, F., Elliott, H., Smith, L. D., Matthews, B., Jennings, K., Crossman, J., Williams, G., Miller, D., Harold, B., Gurnett, P., Jagodzinski, L., Smith, J., & Weldon, S. (2023). A systematic scoping review on the evidence behind debriefing practices for the wellbeing/emotional outcomes of healthcare workers. Frontiers in Psychiatry, 14. https://doi.org/10.3389/fpsyt.2023.1078797 Gilmartin, S., Martin, L., Kenny, S., Callanan, I., & Salter, N. (2020). Promoting hot debriefing in an emergency department. BMJ Open Quality, 9(3), e000913. https://doi.org/10.1136/bmjoq-2020-000913 Harder, N., Lemoine, J., & Harwood, R. (2019). Psychological outcomes of debriefing healthcare providers who experience expected and unexpected patient death in clinical or simulation experiences: A scoping review. Journal of Clinical Nursing, 29(3–4), 330–346. https://doi.org/10.1111/jocn.15085 Holbert E. & Dellasega C. (2021). De-stressing from distress: Preliminary evaluation of a nurse-led brief debriefing program. Crit Care Nurs Q. 44(2), 230-234. doi: 10.1097/CNQ.0000000000000356. PMID: 33595969. Lyman, K. (2021). The relationship between post-resuscitation debriefings and perceptions of teamwork in emergency department nurses. International Emergency Nursing, 57, 1–4. https://doi.org/10.1016/j.ienj.2021.101005 Melnyk, B. M. & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Lippincott, Williams, & Wilkins Morley, G. & Horsburgh, C.C. (2023). Reflective debriefs as a response to moral distress: Two case study examples. HEC Forum, 35(1), 1-20. https://doi.org/10.1007/s10730-021-09441-z 21 Paquay, M., Simon, L., Ancion, A., Graas, G., & Ghuysen, A. (2023). A success story of clinical debriefings: Lessons learned to promote impact and sustainability. Frontiers in Public Health, 11, 1188594. https://doi.org/10.3389/fpubh.2023.1188594 Przednowek, T., Stacey, C., Baird, K., Nolan, R., Kellar, J., & Corser W.D. (2021). Implementation of a rapid post-code debrief quality improvement project in a community emergency department setting. SMRJ, 6(1), doi:10.51894/001c.21376 Richins, M.T., Gauntlett, L., Tehrani, N. Hesketh, Weston, D., Carter, H., & Amlot, R. (2020). Early posttrauma interventions in organizations: A scoping review. Frontiers in Psychology, 11, 1176. https://doi.org/10.3389/fpsyg.2020.01176 Sandoval, J. B., Hooshmand, M., & Sarik, D. A. (2023). Beating burnout with project D.E.A.R.: Debriefing event for analysis and recovery. Nurse Leader, 21(5), 579-585. https://doi.org/10.1016/j.mnl.2023.04.008 Toews, A.J., Martin, D.E., & Chernomas, W.M. (2021). Clinical debriefing: A concept analysis. J Clin Nurs, 30, 1491-1501. https://doi.org/10.1111/jocn.15636 22 Appendix A Task Force Meeting Poster 23 Appendix B PowerPoint Presentation 24 25 26 27 28 Appendix C Survey Debriefing in the ICU An anonymous survey How satisfied are you with the current process of debriefing after an unexpected patient death? a) b) c) d) Highly Satisfied It’s alright Unsatisfied What process? I replay situations at home, wondering what I could have done differently a) Always b) Sometimes c) Never Do you feel comfortable sharing your thoughts and feelings with your coworkers? a) b) c) d) Always Sometimes Depends on the coworker Never Debriefing helps me process my emotions, receive constructive feedback from coworkers, and strengthen my work-life relationships. a) b) c) d) Always Sometimes Hardly ever Never The debriefing is well led by a trained facilitator who I feel I can trust, speak freely with, and learn from. a) b) c) d) Always Sometimes Never Depends on the facilitator Debriefing helps me to improve my practice by openly discussing opportunities for improvement. a) b) c) d) Always Sometimes Never N/A 29 Appendix D Timeline