The impact of Critical Incident Stress Debriefing on coping in emergency health care providers : a rapid review
Abstract
Emergency health care providers (EHCPs) are medical specialists who are trained to
provide victims of sudden or acute illness or injury with emergency care and transportation to
a hospital. An inherent aspect of this occupation is being exposed to traumatic scenes and
incidents on a very regular basis. Without constructive coping, the possibility for the
development of problems such as burnout, anxiety, depression or even PTSD increases
drastically.
Critical Incident Stress Management (CISM) was developed by Mitchell, originally
with the primary target group being first responders to critical incidents (Mitchell, Sakraida &
Kameg, 2003).Critical Incident Stress Debriefing (CISD) forms the fifth step or element of
the CISM process and aims to reconstruct the traumatic event, to allow for ventilation,
normalising specific reactions to the event and also to limit the development of maladaptive
cognitive, behavioural and coping responses. CISD is often presented in isolation as a once
off intervention following a critical incident. This entails a group meeting within 72 hours
after the incident for an average of 1-3 hours. However, CISD was never intended to be
applied in isolation, rather as a step in CISM.
As there is a lack of data available on the impact of CISD as a stand-alone intervention,
this study attempts to answer the following question: What scientific evidence exists
regarding the impact of CISD used in isolation on coping in EHCPs? The researcher expects
to indicate through this research whether it is recommended to use CISD in isolation, as well
as how CISD can specifically be applied in a South African context where EHCPs are often
exposed to critical incidents without adequate training or infrastructure.
The aim was to explore the impact CISD as stand-alone intervention has on the
coping of EHCPs. Impact was evaluated according to three guidelines, namely the nature,
relevance and effectiveness of CISD.
A rapid review was conducted, entailing a shorter timeframe and utilising less
resources than a traditional systematic review. Six articles were identified which complied
with the inclusion criteria. The Joanna Briggs Institute (JBI) approach was used to maintain a
clear distinction between quantitative and qualitative data, with individual synthesis done
before the final synthesis of both types of research. Thematic analysis was employed to
convert both quantitative and qualitative data to themes related to the nature, relevance and
effectiveness of CISD as stand-alone intervention.
In essence, it was found that, although CISD as stand-alone intervention for EHCPs has
both positive and negative outcomes, it is clear that CISD leaves a void between what is
offered and what is subjectively needed by EHCPs. It is therefore difficult to clearly indicate
to what extent CISD as stand-alone intervention is effective or not. It has been argued that
CISD can be relevant and effective on its own, but not in its current reactive format which
does not allow for effectively addressing the needs EHCPs have.
The most important limitation of this study is that only six articles, none within the
South African context, adhere to all the search terms and inclusion criteria in the current
study. Generalising the findings of this study is therefore not possible and more research is
needed before any practical recommendations can be made.
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