Abstract
Nurses, who experience a critical incident as a sudden unexpected event, can be devastated as second victims (Buhlmann et al., 2021; Edrees & Wu, 2021). The associated psychological stress negatively impacts coping, resulting in an increased risk of fixating on or reliving the critical incident for many years (Buhlmann et al., 2021; Cantu, 2020; Harvey & Tapp, 2020). The consequential impact on coping increases the likelihood for second victims to experience secondary traumatic stress, post-traumatic stress disorder, or other mental health issues. A lack of organizational support can lead to organizational consequences such as higher nursing attrition, poor patient safety outcomes, and poor employee satisfaction rates (Edrees & Wu, 2021; Werthman et al., 2021). Administration must be prepared to effectively and efficiently mitigate this impact. This quality improvement project aimed to raise awareness of the negative consequences of critical incidents, provide resources to aid in the healing process of second victims, and identify quality improvement initiatives for the organization. With the location having limited support for second victims, an 87-bed rural hospital was ideal for implementation. Facilitators used a revised DISCOVER PHASE tool, created by Servotte et al. (2020), to guide debriefing sessions. These group debriefings lasted 10 minutes following a critical incident. A critical incident microdebriefing allowed staff members to vent concerns without fear of retribution to counter the negative impact of high-stress situations. Before implementing the addition of microdebriefing, a critical incident needs assessment was conducted through an anonymous online survey. After implementing the microdebriefings, the survey was repeated. The project results revealed a reduction in the impact critical incidents had on second victims. Participants indicated an improvement in the quality of care rendered to patients and their personal work ethic. A large majority (78.3%) of the participants were able to identify available resources after a critical incident. Lastly, improvements in processes and protocols were identified and immediately mitigated. Nurses identified the benefits and recommended critical incident microdebriefings for all new graduate nurses. Recommendations for future projects include implementing extended resources for second victims, and increasing awareness of the lack of resources available to rural healthcare facilities.
Notes
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References:
Buhlmann, M., Ewens, B., & Rashidi, A. (2021). The impact of critical incidents on nurses and midwives: A systematic review. Journal of Clinical Nursing, 30(9–10), 1195–1205. https://doi.org/10.1111/jocn.15608
Cantu, L., & Thomas, L. (2020). Baseline well-being, perceptions of critical incidents, and openness to debriefing in community hospital emergency department clinical staff before COVID-19: A cross-sectional study. BMC Emergency Medicine, 20, Article 82. https://doi.org/10.1186/s12873-020-00372-5
Edrees, H. H., & Wu, A. W. (2021). Does one size fit all? Assessing the need for organizational second victim support programs. Journal of Patient Safety, 17(3), e247–e254. https://doi.org/10.1097/PTS.0000000000000321
Harvey, G., & Tapp, D. M. (2020). Exploring the meaning of critical incident stress experienced by intensive care unit nurses. Nursing Inquiry, 27(4), Article e12365. https://doi.org/10.1111/nin.12365
Servotte, J.-C., Welch-Horan, T. B., Mullan, P., Piazza, J., Ghuysen, A., & Szyld, D. (2020). Development and implementation of an end-of-shift clinical debriefing method for emergency departments during COVID-19. Advances in Simulation, 5, Article 32. https://doi.org/10.1186/s41077-020-00150-0
Werthman, J. A., Brown, A., Cole, I., Sells, J. R., Dharmasukrit, C., Rovinski-Wagner, C., & Tasseff, T. L. (2021). Second victim phenomenon and nursing support: An integrative review. Journal of Radiology Nursing, 40(2), 139–145. https://doi.org/10.1016/j.jradnu.2020.12.014
Sigma Membership
Epsilon Epsilon
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Quality Improvement
Research Approach
Other
Keywords:
Policy and Advocacy, Stress and Coping, Workforce, Debriefing, Critical Incident Stress, Victims--Psychosocial Factors, Second Victim, Rural Hospitals
Recommended Citation
Nelson, Adrienne Nicole; Walloch, Judith; Huggins, Sheila; McConkey, Teresa; and Williams, Kathy, "Effectiveness of a Microdebriefing Intervention in a Rural Hospital: A Quality Improvement Project" (2026). International Nursing Research Congress (INRC). 95.
https://www.sigmarepository.org/inrc/2026/presentations_2026/95
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-07-29
Effectiveness of a Microdebriefing Intervention in a Rural Hospital: A Quality Improvement Project
Toronto, Ontario, Canada
Nurses, who experience a critical incident as a sudden unexpected event, can be devastated as second victims (Buhlmann et al., 2021; Edrees & Wu, 2021). The associated psychological stress negatively impacts coping, resulting in an increased risk of fixating on or reliving the critical incident for many years (Buhlmann et al., 2021; Cantu, 2020; Harvey & Tapp, 2020). The consequential impact on coping increases the likelihood for second victims to experience secondary traumatic stress, post-traumatic stress disorder, or other mental health issues. A lack of organizational support can lead to organizational consequences such as higher nursing attrition, poor patient safety outcomes, and poor employee satisfaction rates (Edrees & Wu, 2021; Werthman et al., 2021). Administration must be prepared to effectively and efficiently mitigate this impact. This quality improvement project aimed to raise awareness of the negative consequences of critical incidents, provide resources to aid in the healing process of second victims, and identify quality improvement initiatives for the organization. With the location having limited support for second victims, an 87-bed rural hospital was ideal for implementation. Facilitators used a revised DISCOVER PHASE tool, created by Servotte et al. (2020), to guide debriefing sessions. These group debriefings lasted 10 minutes following a critical incident. A critical incident microdebriefing allowed staff members to vent concerns without fear of retribution to counter the negative impact of high-stress situations. Before implementing the addition of microdebriefing, a critical incident needs assessment was conducted through an anonymous online survey. After implementing the microdebriefings, the survey was repeated. The project results revealed a reduction in the impact critical incidents had on second victims. Participants indicated an improvement in the quality of care rendered to patients and their personal work ethic. A large majority (78.3%) of the participants were able to identify available resources after a critical incident. Lastly, improvements in processes and protocols were identified and immediately mitigated. Nurses identified the benefits and recommended critical incident microdebriefings for all new graduate nurses. Recommendations for future projects include implementing extended resources for second victims, and increasing awareness of the lack of resources available to rural healthcare facilities.
Description
Critical incidents can negatively affect nurses. A lack of organizational support can lead to complex mental health issues that compromise patient safety, increase nursing attrition, and reduce employee satisfaction. A quality improvement project implemented at an 87-bed rural hospital raised awareness of critical incidents and provided resources for second victims. Results indicated reduced stress, better care and work ethic, and support for microdebriefings for new graduate nurses.