Date of Award

Spring 2025

Project Type

Clinical Doctorate

College or School

CHHS

Department

Nursing

Program or Major

Doctor of Nursing Practice

Degree Name

Other

First Advisor

Cathleen Colleran and Courtney Coffey

Second Advisor

Kimberly Noonan

Third Advisor

Joni Watson

Abstract

Background: A critical incident is a sudden, unexpected, emotionally distressing event commonly experienced by oncology nurses. Debriefing is an evidence-based best practice that facilitates communication, reflection, and learning to identify quality improvement opportunities to enhance clinical practice, patient safety, and quality of care. However, debriefing within oncology care settings is inconsistent despite the demonstrated benefit and availability of frameworks. Infusion-related reaction management follows an algorithm that directs care delivery, aligning with a care bundle approach. Care bundles, when consistently and reliably applied, help identify connections between the critical incident (i.e., infusion-related reaction) and opportunities for improvement to ensure clinicians follow best practices and achieve optimal patient outcomes.

Purpose: This manuscript details critical incident debriefing implementation following infusion-related reactions in an adult ambulatory setting and evaluates its impact on oncology nurses and the infusion-related reaction care bundle.

Methods: Over eight weeks, a nurse clinical specialist facilitated critical incident debriefing (n= 42) following infusion-related reactions (n= 46) at three adult ambulatory oncology clinics with the highest reported incidence of infusion reactions (n = 376). The project leader invited all involved nurses to participate. Nurses debriefed using the STOP5-Modified model and assessed the event using the Debriefing Experience Scale (DES). The STOP5-Modified captured the length of the debrief, number of participants, and narratives from the Thing That Went Well and Opportunities to Improve sections. The DES measured outcomes of experience and the importance of experience through four subscales (Learning and Making Connections, Analyzing Thoughts and Feelings, Facilitator Skill in Conducting the Debriefing, and Appropriate Facilitator Guidance). The Kurt Lewin Change Theory guided the project. Participation was voluntary, and data collection was anonymous.

Results: Debriefing was feasible across all project implementation sites. Nurses debriefed 91.3% of reactions, averaging 6.6 minutes, with DES scores showing favorable opinions about participants’ experiences and perceived importance. Average care bundle adherence was 86.2%. Qualitative analysis revealed positive themes, including “quick response” (71.4%) and “teamwork” (45.2%). Almost half of the reactions had no identified areas for improvement, citing “none” (45.2%) as a frequent response for improvement areas.

Conclusion: Facilitated critical incident debriefing is a feasible and effective best practice following infusion-related reactions for enhancing nurse experience, supporting care bundle adherence, and promoting a culture of continuous learning in adult ambulatory oncology care settings.

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