Bakgrund: Arbetet på en intensivvårdsavdelning innefattar ofta ett högt tempo och intensivvårdssjuksköterskan förväntas utöver sin kunskap inom medicin och omvårdnad, kunna hantera de psykologiska reaktionerna som kan uppstå i samband med kritiska tillstånd.Debriefing och avlastande samtal är båda verktyg för att bearbeta känslor då en svår situation inträffat. Syfte: Att belysa intensivvårdssjuksköterskors upplevelser om vad som påverkar behovet av debriefing och avlastande samtal i det dagliga arbetet. Metod: Genom ett strategiskt urval valdes totalt 10 intensivvårssjuksköterskor ut att delta i denna deskriptiva kvalitativa studie, som genomfördes på tre olika intensivvårdsavdelningar i Sverige. Halvstrukturerade intervjuer utfördes och analyserades i enlighet med Granheim och Lundmans metod för kvalitativ innehållsanalys. Resultat: Sjuksköterskorna upplevde generellt ett behov av debriefing/avlastande samtal i samband med större olyckor. Behovet påverkades av olika faktorer som presenteras i kategorierna; akut och/eller oväntad händelse, etiska dilemman, igenkännande och personligt engagemang, personliga förmågor, erfarenhet, tid och ansvar. Slutsats: Erfarenhet i yrket underlättade för sjuksköterskorna att bearbeta svåra händelser på egen hand, medan igenkännande, i form av sjuksköterskans egna livsituation och föräldraskap, ökade behovet av debriefing/avlastande samtal. / Background: The work at an intensive care unit often involves a high tempo and the specialist nurse in intensive care is expected, in addition to the medical and nursing knowledge, to deal with the psychological reactions that may arise in critical conditions. Debriefing and defusing are both tools to process emotions when a difficult situation occurred. Aim: To illustrate intensive carenurses experience of what effects the need of debriefing and defusing in the daily work. Method:This descriptive qualitative study was conducted in three different intensive care units in Sweden.Through a strategic selection were a total of 10 intensive care nurses selected to participate in semi-structured interviews. Which were performed and analyzed in accordance with Granheimand Lundman's method for content analysis. Result: Intensive care nurses generally experience aneed of debriefing/defusing for major accidents. The need is affected by various factors which are presented in following categories; acute or unexpected situation, ethical dilemmas, recognition and personal engagement, personal abilities, experience, time and responsibility. Conclusion:Professional experience made it easier for intensive care nurses to process difficult situations on their own, while recognition, such as life situation and parenthood, increased the need for debriefing/defusing.

A concepção de que o uso da simulação realística agrega diferencial ao processo de formação dos enfermeiros tem impulsionado instituições de ensino superior a conhecerem essa estratégia metodológica. Como parte da simulação, o debriefing tem sido apontado como um dos momentos mais privilegiados para a aprendizagem. Com base no pressuposto de que graduandos de enfermagem apresentam melhor desempenho clínico na assistência de enfermagem em sala de vacina, utilizando-se o debriefing após cenários realísticos como método de ensino, esse estudo teve como objetivos comparar o desempenho clínico de discentes que passaram por cenários de aprendizagem com e sem debriefing e verificar sua opinião quanto ao uso de cenários com debriefing. Tratou-se de um e estudo longitudinal, prospectivo, de intervenção, randomizado em crossover, de abordagem quantitativa, do tipo antes e depois, que investigou a ocorrência de diferenças nos resultados dos exames de desempenho realizados por discentes que passaram por cenários com e sem debriefing em um Centro de Simulação. A população do estudo foi composta por 120 alunos do semestre de graduação em Enfermagem de uma Universidade privada. A aleatorização foi realizada com apoio estatístico em dois grupos, experimental e controle, considerando-se como variável interveniente ao processo ensino e aprendizagem os tercis de notas dos alunos no primeiro exame de desempenho clínico. As fases da pesquisa incluíram a ministração de aula teórica e de aula prática demonstrativa sobre imunização infantil e procedimentos para administração de vacinas pela docente da disciplina para todos os alunos. Depois dessa etapa, foi realizado o primeiro exame de desempenho clínico que serviu como medida basal e subsidiou o processo de randomização. Após a randomização, o grupo experimental realizou cenários com debriefing e o grupo controle realizou cenários sem debriefing, e ambos os grupos foram submetidos à intervenção, ou seja, ao segundo exame de desempenho clínico. Por fim, para garantir a igualdade de oportunidade de aprendizagem, foi realizada a troca dos grupos (crossover): o grupo controle passou a realizar cenários com debriefing e o grupo experimental cenários sem debriefing, realizando-se ao final o terceiro exame de desempenho clínico. Os resultados da pesquisa mostraram que houve melhora no desempenho do grupo experimental tanto em relação ao exame medida basal quanto em comparação com o grupo controle (p <0,001), no exame de desempenho pós intervenção e no terceiro exame, após o crossover. Esse resultado permitiu constatar que o debriefing foi eficaz para melhorar a atuação dos alunos nos exames de desempenho clínico na assistência de enfermagem em sala de vacina. Quanto a opinião dos alunos sobre o debriefing, observou-se que a grande maioria (97,1%) considerou essa estratégia importante para o aprendizado, pois oferece a oportunidade de mais esclarecimentos e de reflexão sobre a prática para o aperfeiçoamento da assistência. Diante dos resultados, conclui-se que o uso de cenários com debriefing efetivamente se constitui estratégia facilitadora do processo ensino e aprendizagem na graduação em enfermagem. / The conception of using realistic simulation, which brings a difference to the education process of nurses, has fostered higher education institutions to learn this teaching strategy. As part of simulation, debriefing has been pointed out as one of the most promising learning resources. Based on the assumption that undergraduate nursing students present better clinical performance in nursing care at the vaccination room using debriefing after realistic role playing as a teaching method, this study aimed to compare clinical performance of students who were submitted to learning role playing with and without debriefing and to verify their opinions regarding the use of roles with debriefing. It´s an interventional, prospective longitudinal study, randomized in crossover, of quantitative approach, and before and after type. It sought the occurrence of differences in performance exam results made with students with went through role playing with and without debriefing at a Simulation Center. The population of the study was made of 120 students in the fourth semester of nursing graduation at a private university. Randomization was made with statistical support into two groups, experimental and control, considering as intervenient variable to teaching and learning process one-third of students´ grades from the first clinical performance exam. The phases of research included theoretical and practical classes on childhood immunization and vaccination administration procedures by the subject teacher to all students. After this step, it was made the first clinical performance exam that served as a baseline measure and it subsidized the randomization process. After randomization, the experimental group had role playing with debriefing and the control group had role playing without debriefing, and both groups were submitted to intervention, that is, a second clinical performance exam. At last, to ensure equity of opportunity in learning, the groups took turns (crossover): The control group started role playing with debriefing and the experimental group had role playing without debriefing, having at the end, the third clinical performance exam. Research outcomes pointed out that there was an improvement in performance by the experimental group as much in exam baseline measures as in comparison to the control group (p <0.001) in the performance exam after intervention and in the third exam, after crossover. This result made it possible to verify that debriefing was efficient to improve students´ practice in the clinical performance exams in nursing care at the vaccination room. Regarding the students´ opinion on debriefing, it was observed that most of them (97.1%) considered this strategy important for learning, as it provides an opportunity for further clarifications and for reflections on practice for care improvement. According to these results, it can be concluded that the use of role playing with debriefing proves effectively to be a facilitating strategy in teaching and learning process of nursing graduation.

Purpose- This article examined the post-game debriefing of a student-created board game on the topic of malaria, taken from UNICEF and other international agencies’ Facts for Life. Design/Methodology/Approach- A group of university health students participated in the play of the game and the debriefing. Initial debriefing of seven steps(key themes) occurred through written format, followed by an oral debriefing. Findings – Major categories from the written debriefing by steps, key category response, and number of categories were as follows: For experience recall – how to prevent malaria, nine response categories; for feelings – felt informed, felt happy, nine response categories; for enjoyment – learned new information, game was fun, 11 response categories; for importance – malaria prevention, 12 response categories; for new information learned – malaria affects pregnancy, 10 response categories; for new information to learn – multiple topics such as strategies to prevent malaria, 13 response categories; for improvements as suggestions – add more questions, nine response categories. Follow up oral debriefing supported the written debriefing categories, as well as yielding some additional categories. The students suggested at least 70 response categories after the play of the game. Conclusion- This study demonstrates the applicability of a student created and played board game based on the Facts for Life topic of malaria, as a vehicle for health topic discussion. A combined written and oral debriefing approach complimented each other in an educational gaming strategy. Recommendations – Game debriefing is a valuable and essential tool to be included in a health educational gaming strategy. The use of this malaria game should be extended for play in other non-formal settings. Key words: Malaria, board-game, written debriefing, oral debriefing, student created games, public health education, health education

Bakgrund: Akutsjuksköterskan är specialiserad inom akutsjukvård och ska klara av att hantera oväntade och oförutsägbara situationer som exempelvis hjärtstopp. Akutsjuksköterskor hanterar årligen flertalet patienter som drabbas av hjärtstopp, där den vanligaste orsaken är bakomliggande hjärt-och kärlsjukdom. Trots insatser med HLR svävar den drabbade mellan liv och död. Detta kan leda till negativa känslor och upplevelse av stress hos de som deltar i situationen. Sjuksköterskor upplever att reflektion efter dödsfall kan användas för hantering av stress och ge ett känslomässigt stöd. Syfte: Syftet med studien var att belysa sjuksköterskors erfarenheter av reflektion efter hjärtstopp inom akutsjukvården. Metod: En kvalitativ intervjustudie med induktiv ansats där 14 informanter intervjuades. Intervjuerna analyserades med en innehållsanalys.  Resultat: I resultatet framkom fyra kategorier, vilka var: faktorer som påverkar behovet av reflektion, reflektion som hjälp att komma vidare efter hjärtstopp, att hitta utrymme för reflektion samt deltagarna påverkar reflektionens kvalitet. Kategorierna resulterade i ett övergripande tema: Reflektion - ett mellanmänskligt stöd med varierande möjligheter och behov som innebär att reflektion kan vara ett stöd i sjuksköterskans profession och person tillsammans med arbetsgruppen. Behovet av reflektion skiljer sig beroende på person och situation. Även möjligheterna till reflektion varierar eftersom tiden ofta saknas. Slutsatser: Det finns behov av att utveckla reflektion inom akutsjukvården. Stress och ohälsa hos sjuksköterskorna riskerar att leda till en sämre vård för patienterna. Reflektion möjliggör en minskning av den mentala stressen och därmed ge en bättre upplevd hälsa hos sjuksköterskorna för att i slutändan ge bättre vård till patienterna. / Background: The emergency nurse is specialized in emergency care and must be able to handle unexpected and unpredictable situations such as cardiac arrest. Emergency nurses handle several patients with cardiac arrest every year, the most common cause is underlying cardiovascular disease.  Despite efforts with CPR, the victim hovers between life and death. This can lead to negative emotions and stress for those involved in the situation. Healthcare professionals find that reflection after death can be used to manage stress and provide emotional support. Aim: The aim of the study was to describe nurses’ experiences of debriefing after cardiac arrest within emergency care.  Method: A qualitative interview study with an inductive approach and 14 informants were interviewed. The interviews were analyzed with a content analysis.  Results: The result emerged into four categories, which were: factors that influence the need for reflection, reflection as a help to move on after a cardiac arrest, finding space for reflection and the participants influence the quality of reflection. The categories resulted into an overarching theme: Reflection - an interpersonal support with varying possibilities and needs which means that reflection can be a support for the nurse in her professional and personal life together with the co-workers. The need for reflection varies depending on the person and situation. The possibilities for reflection vary due to lack of time.  Conclusions: There is a need to develop reflection within emergency care. Stress and poor health among the nurses could risk leading to inferior care for the patients. Reflection enables a decrease in mental stress and thus provides a better perceived health for the nurses to ultimately provide better care to the patients.

The overall aim was to investigate bachelor nursing students’ experiences with simulation as a learning approach conducted under various conditions. Additionally, the aim was to translate and validate questionnaires for the evaluation of simulation in a Norwegian context. Methods: Quantitative and qualitative methods were used. Nursing students responded to three questionnaires after attending either low- or high-fidelity simulation. Data were analyzed with statistics (I). Two evaluation questionnaires were subjected to a principal components analysis (II, III). Data were obtained from nursing students through focus group interviews, and analyzed with a qualitative content analysis (IV). Main findings: Independent of the fidelity level in the simulation and educational level, the students reported satisfaction and that the emphasized features in learning were present. Those who had used a paper/pencil case study were the most satisfied (I). Debriefing was reported to be crucial for learning, but in particular by attending the large groups, also as a stressful and intrusive situation (IV).The Norwegian version of the questionnaire, the Student Satisfaction and Self-Confidence Scale, revealed no stable factor solution (II). The translated version of the Debriefing Experience Scale was shown to hold a good potential for evaluating debriefing, but benefited from reducing the subscales (III). To ensure safety and security were reported to be a prerequisite for learning, with the students requesting a more frequent use of simulation and a higher degree of familiarity with active learning in their program in general (IV). Conclusions: Simulation at all fidelity levels should be used in nursing education. To exploit the potential, the learning approaches should be integrated into the program in general through a systematic and structured building of a learning community. A further validation and testing of the questionnaires in different programs and contexts is needed.

Samfattning   Bakgrund: I vår vardag världen över drabbas människor oavsett kön och ålder av olyckor, dödsfall och andra traumatiska händelser. Vissa yrken medför en större risk att utsättas för traumatiska händelser. Exempel på dessa är ambulans, räddningspersonal, polis och vårdpersonal inom främst akutsjukvård. Dessa händelser kan ibland bli personen övermäktigt. Ett sätt att motverka bl.a. utbrändhet och posttraumatiskt stressymptom (PTSD) hos vårdpersonalen är att genomföra debriefingsamtal. Detta genomförs med den vårdpersonal som varit delaktig i en traumatisk händelse.     Syfte: Syftet med denna studie var att beskriva erfarenheten av debriefing hos vårdpersonal inom akutsjukvården i samband med traumatiska händelser i sin yrkesutövning.   Metod: Litteraturstudie som totalt innehåller 10 vetenskapliga artiklar varav fem är kvalitativa och fem är kvantitativa.   Resultat: Studieresultatet påvisar att debriefing uppfattas som ett positiv redskap när det gäller avlastning efter en traumatisk händelse för vårdpersonalen inom akutsjukvården. De främsta faktorerna som lyfts i studien är tid och plats för debriefing, debriefingens inverkan på kommunikationen mellan vårdpersonalen, val av debriefingledare och behovet av väl utformade riktlinjer för debriefingen.   Slutsats: I föreliggande studie påvisas att debriefing bör betraktas som ett effektivt verktyg att motverka psykisk ohälsa hos vårdpersonalen och att debriefing även förstärker kommunikationen mellan de olika professionella yrkesgrupperna inom akutsjukvården. Studien visar även att det är viktigt med väl utformade riktlinjer för att debriefingens syfte skall uppnås. / Abstract Background: In our everyday lives worldwide, people are affected regardless of gender and age by accidents, deaths and other traumatic events. Some professions involve a greater risk of being exposed to traumatic events. Examples of these are ambulance, emergency personnel, police and health care personnel, primarily in emergency care. These events can sometimes become overpowering. One way to counteract burnout and post-traumatic stress symptom (PTSD) in healthcare professionals is to carry out debriefing talks. This is done with the healthcare staff who has participated in a traumatic event.   Aim: The purpose of this study was to describe the experience of debriefing in healthcare professionals in emergency care in connection with traumatic events in their professional practice.   Method: Literature study that contains a total of 10 scientific articles, five of which are qualitative and five are quantitative.   Results: The study results show that debriefing is perceived as a positive tool when it comes to unloading after a traumatic event for the healthcare staff in emergency care. The main factors raised in the study are time and place for debriefing, debriefing impact on the communication between the healthcare staff, the choice of debriefing leader and the need for well-designed guidelines for debriefing.   Conclusion: The present study demonstrates that debriefing should be regarded as an effective tool for counteracting mental illness in the healthcare staff and that debriefing also reinforces communication between the various professional occupational groups in emergency care. The study also shows that well-designed guidelines are important for achieving the purpose of the debriefing.

Pågående Dödligt Våld har blivit ett allt mer diskuterat ämne inom ambulanssjukvården den senaste tiden. Det framkommer att en ökad hotbild har utvecklats över Europa och med detta ökar kravet på sjukvården gällande förberedelse och kunskap inom ämnet. Det kan röra sig om en eller flera gärningsmän som genomför ett brott med hjälp av vapen eller fordon och ofta är händelsen över inom 15 minuter. Som ambulanspersonal finns en risk att råka ut för en PDV-situation och denna studies syfte var att belysa ambulanspersonals erfarenheter av agerande i en situation med pågående dödligt våld. För att svara till studiens syfte valde författarna att använda sig av en kvalitativ intervjustudie med induktiv ansats. Under studiens gång intervjuades sex personer, varav två kvinnor och fyra män och därefter transkriberades och sammanställdes intervjuerna för att ett resultat skulle kunna framarbetas. Resultatet framställdes efter granskning med hjälp av Elo och Kyngäs (2008) mall för kvalitativ innehållsanalys och redovisades därefter genom fyra huvudkategorier och tio subkategorier. Resultatet visar på att den ambulanspersonal som agerat i en PDV-situation var nöjd med sin egen och sina kollegors insats, men känner en fortsatt oro över att behöva agera i en liknande situation igen. En utmaning finns därför i att försöka skapa en trygghet kring fenomenet med hjälp av ytterligare mental och praktisk utbildning.

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Nuclear power production carries potential risks both for the environment and for the work force. Different safety measures are employed and they stem from local rules as well as from regulatory authorities. This work describes the development of a safety promoting tool at Forsmark Power Plant, one of Sweden’s three Nuclear power plants. We describe the development of a computer based system for Pre-Job Briefing and Post-Job Debriefing. The organization at Forsmark did not have satisfactory routines and documentation for these operative work procedures, mainly because the large organization and the different sections function relatively independent from each other. Hence the working culture and organization has prevented the development of a unified work procedure for service and inspection work. This master thesis has two parts. A compilation has been made from multiple interviews in order to develop the requirements of a system for Pre-Job Briefing and Post-Job Debriefing. Following this an IT based system has been developed in order to handle the specified procedures. The concept of the user-centered system design process and usability methods has been used. The developed system has been met with acceptance and will be employed in production. It is concluded that the systematic analysis and the employment of the designed system may augment the ability for the organization at Forsmark to live up to the guidelines set by regulatory authorities and thereby create a more secure work environment and power production.