Bhanji F, Donaghue AJ, Wolff MS Part 14: Education: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015; 132:S561-S573

Bledson BE. Critical incident stress management (CISM) benefit or risk for emergency services?. Prehosp Emerg Care. 2003; 7:(2)277-279

Boscarino JA, Adams RE, Figley CR. A prospective cohort study of the effectiveness of employer-sponsored crisis interventions after a major disaster. Int J Emerg Ment Health. 2005; 7:(1)9-22

Bride BE, Robinson MM, Yieds B, Figley CR. Development and validation of the secondary traumatic stress scale. Recognising Social Work Practice. 2004; 14:(1)27-35

Burbeck R, Coomber S, Robinson SM, Todd C. Occupational stress in consultants in accident and emergency medicine: a national survey of levels of stress at work. Emerg Med J. 2002; 19:(3)234-238

Burchill C. Critical incident stress debriefing: helpful, harmful, or neither?. J Emerg Nurs. 2019; 45:(6)611-612

Clark P, Polivka B, Zwart M, Sanders R. Paediatric emergency department staff preferences for critical incident stress debriefing. J Emerg Nurs. 2019; 45:(4)403-410

Fitzgerald K, Yates P, Benger J, Harris A. The psychological health and well-being of emergency medicine consultants in the UK. Emerg Med J. 2017; 34:(7)430-435

García-Izquierdo M, Ríos-Rísuez MI. The relationship between psychosocial job stress and burnout in emergency departments: an exploratory study. Nurs Outlook. 2012; 60:(5)322-329

Gallagher S, McGilloway S. Experience of critical incident stress among ambulance service staff and relationship to psychological symptoms. Int J Emerg Ment Health. 2009; 11:(4)235-248

Glasper A. Strategies to promote the emotional health of nurses and other NHS staff. Br J Nurs. 2020; 29:(4)248-249

Greenberg N, Langston V, Jones N. Trauma Risk Management (TRiM) in the UK armed forces. JR Army Med Corps. 2008; 154:(2)123-126

Hagenaars MA, van Minnen A. Posttraumatic growth in exposure therapy for PTSD. J Trauma Stress. 2010; 23:(4)504-508

Hawker DM, Durkin J, Hawker DS. To debrief or not debrief our heroes: that is the question. Clin Psychol Psychother. 2011; 18:(6)453-463

Kessler DO, Cheng M, Mullan PC. Debriefing in the emergency department after clinical events: a practical guide. Ann Emerg Med. 2015; 65:(6)690-698

Coronavirus is whipping up a mental storm for NHS workers. 2020. (accessed 13 October 2021)

Lai J, Simeng M, Wang Y Factors associated with mental health outcomes among health care workers exposed to coronavirus disease. JAMA Network Open. 2020; 3:(3)

Lubin G, Sids C, Vishne T, Shochat T, Ostfield Y, Shmushkevitz M. Acute stress disorder and post-traumatic stress disorder among medical personnel in Judea and Samaria areas in the years 2000-2003. Mil Med. 2007; 172:(4)376-378

McAleese A, Diamond A, Curran D. An assessment of psychological need in emergency medical staff in the Northern Health and Social Care Trust area. Ulster Med J. 2016; 85:(2)92-98

Minnie L, Goodman S, Wallis LA. Exposure to daily trauma: the exposure and coping mechanism of emergency medical personnel. A cross sectional study. African Journal of Emergency Medicine. 2015; 5:(1)12-18

Mitchell JT, Everley GS The critical incident stress debriefing (CISD and the prevention of work-related traumatic stress among high-risk occupational groups. In: Everley GS, Lating JM (eds). : Plenum Press; 1995

Morrison LE, Joy JP. Secondary traumatic stress in the emergency department. J Adv Nurs. 2016; 72:(11)2894-2906

National Institute for Health and Care Excellence. Post-traumatic stress disorder. NICE guideline NG116. 2018. (accessed 19 October 2021)

Ratrout HF, Hamdan-Mansour AM. Secondary traumatic stress among emergency nurses: prevalence, predictors and consequences. Int J Nurs Pract. 2020; 26:(1)

Regel S. Post-trauma support in the workplace: the current status and practice of critical incident stress management (CISM) and psychological debriefing (PD) within organizations in the UK. Occup Med (Lond). 2007; 57:(6)411-416

Rose SC, Bisson J, Churchill R, Wessley S. Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2002; (2)

Sandhu N, Eppich W, Mikrogianakis A, Grant V, Robinson T, Cheng A Postresuscitation debriefing in the pediatric emergency department: a national needs assessment. CJEM. 2014; 16:(5)383-392

Smith J, Flowers P, Larkin M. Interpretative phenomenological analysis: theory, method and research.London: Sage Publications; 2009

Slade M, Rennick-Egglestone S, Blackie L Post-traumatic growth in mental health recovery: qualitative study of narratives. BMJ Open. 2019; 9:(6)

Somville FJ., De Gucht V, Maes S. The impact of occupational hazards and traumatic events among Belgian emergency physicians. Scand J Trauma Resusc Emerg Med. 2016; 24

van Emmerik AAP, Kamphuis JH, Hulsbosch AM, Emmelkamp PMG. Single session debriefing after psychological trauma: a meta-analysis. Lancet. 2002; 766-771

The ‘rescue personality’: fact or fiction?. 2005.

World Health Organization. Psychological debriefing in people exposed to a recent traumatic event. 2012. (accessed 13 October 2021)

Zinns LE, O'Connell KJ, Mullan PC, Ryan LM, Wratney AT. National survey of pediatric emergency medicine fellows on debriefing after medical resuscitation. Pediatr Emerg Care. 2015; 31:(8)551-554

Peer assessment after clinical exposure (PACE): an evaluation of structured peer support for staff in emergency care

28 October 2021
16 min read
Volume 30 · Issue 19



There is an increasing body of evidence that identifies psychological stressors associated with working in emergency medicine. Peer Assessment After Clinical Exposure (PACE) is a structured programme designed to support staff following traumatic or chronic work-related stressful exposure. The first author of this study created the PACE programme and implemented it in one emergency department (ED).


A service evaluation designed to explore the thoughts and experiences of the staff who accessed the PACE support service.


Participants were selected by a non-probability convenience strategy to represent the ED staff population. The study cohort ranged from junior staff nurse level to emergency consultant. Data were collected using a semi-structured interview and examined by the method of interpretative phenomenological analysis.


This study confirmed the findings of previous research that current pressures within the ED include crowding, time pressure and working within an uncontrollable environment. Eight participants identified an absence of previous emotional support resulting in dissociation and avoidance behaviours following traumatic exposure. Overall, the PACE service was well received by the majority of staff (11/12). There was a positive association with the one-to-one element and the educational component helped to reduce the stigma associated with stress reactions after work-related exposure.


PACE received a positive response from staff. This service presently does not exist elsewhere in the NHS so further research will be needed to evaluate its long-term impact and effectiveness on a wider scale.

It is well recognised that emergency medicine staff are exposed to stressful situations on a daily basis (Burbeck et al, 2002; García-Izquierdo and Ríos-Rísuez, 2012; Kessler et al, 2015; McAleese et al, 2016; Somville et al, 2016). The psychological impact of occupational stressors has been widely acknowledged within other professions such as the fire, police and military services. However, despite being identified as a high-risk occupation, few studies have examined the prevalence and impact of mental health issues among staff in the emergency department (ED) (McAleese et al, 2016; Morrison and Joy, 2016; Glasper, 2020; Ratrout and Hamdan-Mansour, 2020).

The current coronavirus pandemic increases the risk of work-related stress and presents challenges for all NHS workers never experienced before, being described as the ‘perfect storm’ for potential stress-related illness for healthcare staff (Khajuri 2020). A cross-sectional study undertaken in China identified mental health distress among front-line healthcare workers, particularly nurses, and emphasised the need for psychological intervention (Lai et al, 2020).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content