Debriefing

1
Debriefing

• Wendy Jo Wilkinson, MSN, ARNP
• Clinical Educator
• METI

2
Logistics of Debriefing

• Debrief as group, may debrief observers
  separately
• Set ground rules for safe environment and
  confidentiality
• All are expected to be active in discussions of
  the events and their performance
• Focus on critical thinking and specific learning
  objectives
• Faculty is facilitator, not evaluator

3
Goals of Debriefing

• One of the most beneficial parts of simulation
  when it is done correctly
• Enhances student learning through a guided review
  of the Simulated Clinical Experience
• Assist students to evaluate
• Their own performance
• The teams performance
• Their understanding of the patient, his/her
  condition and responses to their interventions

4
Goals of Debriefing

• Reinforces Objectives of Simulated Clinical
  Experience (SCE)
• Learners often have a limited picture of what
  happened while involved in simulation while
  involved, they observe only those parts their
  position allows them to (Peters and Vissers,
  2004)
• Assists in learning those things they missed
  while engaged in the SCE

5
Goals of Debriefing

• Encourages Collaboration and Communication
• Enhances Critical Thinking and Problem Solving
• Advantageous to compare different perspectives
  and a joint analysis.
• Safe place to discuss without constraints of time
  and pressure of being in the simulated clinical
  experience
• Develop information seekers/processors by having
  them utilize available resources

6
Professional Learning Environment
7
Process of Debriefing

• I. Introduction
• II. Personal Reactions
• III. Discussion of Events
• IV. Summary

8
I. Introduction

• Communicate facilitators expectations
• Prepare learners to actively analyze and evaluate
  self and simulation activities
• Discuss confidentiality
• Signed statement
• Provide a safe environment for learners to
  express feelings and ask questions
• Mistakes are a part of the learning process

9
II. Personal Reactions

• Recognize and release emotions built up during
  simulation (Fritzsche, Leonard, Boscia,
  Anderson, 2004)

10
Personal Reactions

• Learners who have the opportunity to explore and
  deal with the feelings they experienced during
  simulation will be better prepared to deal with
  them in real clinical situations (Henneman,
  Cunningham, 2005)
• Begin with open-ended questions and use
  reflective responses to their statements
• Ensure that all in small groups have the
  opportunity to respond
• Their responses can guide the discussion of
  events

11
III. Discussion of Events

• Begin with, or whenever appropriate, review
  objectives of the SCE
• As learners begin to discuss the events,
  encourage them to continually analyze the events
  in depth and their feelings, thoughts and
  reactions to them
• Remember, students learn and remember more when
  they participate actively and make their own
  analyses (Duvall Wicklund, 1972)

12
Discussion of Events

• Ask questions like
• How familiar were you with the patients
  condition, treatments, and complications prior to
  the SCE?
• What happened?
• What did you do as a team or individually when
  that happened?
• What was the outcome?
• What would you do differently next time,
  individually, as a team?
• What additional information, knowledge, skills,
  etc. do you think were/are needed in the
  situation, for the future?

13
Good Questions

• Are relevant to the discussion of the SCE and
  keep the students continually thinking and
  processing information
• Do not imply judgment
• Do not provide information or suggestions
• Try to understand what went on in a positive
  supportive way

14
Discussion of Events

• Learners questions can be answered, learners
  thinking can be clarified, teaching points can be
  emphasized
• Published/standardized guidelines can be reviewed
  (Owen Follows, 2006)
• Charting can be reviewed
• Link what has been learned in simulated setting
  to real world (Chiodo Flaim, 1993 Fritzsche,
  Leonard, Boscia, Anderson, 2004 Peter
  Vissers, 2004)

15
Discussion of Events

• View videotape whenever appropriate
• Question errors in judgment as in complacency
  with abnormal vital signs or vigilance errors as
  in the failure to attend to changing status
• Ask about communication with the patient, family
  members and team members
• Discuss errors with protocols/guidelines

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IV. Summary

• Goal is to assist the students in looking at the
  overall experience. What they did, what they
  learned, what they have said they want to improve
  
• Could be done by facilitator or by asking
  open-ended questions of the learners
• Ask what they learned new from the SCE
• Ask what they feel they need to work on,
  individually and as a group

17
Summary

• End on a positive note
• In summary, these are the things you identified
  as going well.
• These are the things you told me you need to work
  on.
• The take home points include.
• I saw improvement in these areas.
• Thank the learners for participating in both the
  SCE and debriefing
• Written Evaluation

18

• "The difficulty lies not so much in developing
  new ideas as in escaping from old ones"
• John Maynard Keynes

19
References/Additional Readings

• Anderson, J. (2005). Debriefing worksheet.
  Unpublished.
• Anderson, J., Cox, S. (n.d.). Strategies for
  successful debriefing Presentation.
• Center for Medical Simulation. (2004, 2005).
  Institute for Medical Simulation comprehensive
  workshop. Author.
• Chiodo, J. L., Flaim, M. L. (1993). The link
  between computer simulations and
• social studies learning Debriefing.
  Social Studies, 84(3), 119-121.
• Dismukes, R. K., Gaba, D. M., Howard, S. K.
  (2006). So many roads Facilitated
• debriefing in healthcare. Simulation in
  Healthcare, 1(1), 23-25.
• Dunn, W. F. (2004). Education theory Does
  simulation really fit? In W. F. Dunn (Ed.).
  Simulators in Critical Care and Beyond. Des
  Plaines, IL Society of Critical Care Medicine.
• Duvall, S., Wicklund, R. A. (1972). A theory of
  objective self awareness. New York,
• NY Academic Press.
• Fritzsche, D. J., Leonard, N. H., Boscia, M. W.,
  Anderson, P. H. (2004). Simulation
• debriefing procedures. Developments in
  Business Simulation and Experiential
• Learning, 31, 337-338.
• Graling, P., Rusynko, B. (2004). Kicking it up
  a notch- successful teaching
• techniques. AORN Journal, 80(3),
  459-475.

20
References/Additional Readings

• Haskvitz, L. M., Koop, E. C. (2004). Students
  struggling in clinical? A new role for
• the patient simulator. Journal of
  Nursing Education, 43(4), 181-184.
• Henneman, E. A., Cunningham, H. (2005). Using
  clinical simulation to teach patient
• safety in an acute/critical care
  nursing course. Nurse Educator, 30(4), 172-177
• Hravnak, M., Tuite, P., Baldisseri, M. (2005).
  Expanding acute care nurse
• practitioner and clinical nurse
  specialist education Invasive procedure training
• and human simulation in critical care.
  AACN Clinical Issues, 16(1), 89-104.
• Jeffries, P. R. (2005). A framework for
  designing, implementing, and evaluating
• simulations used as teaching strategies
  in nursing. Nursing Education
• Perspectives, 26(2), 96-103.
• Knowles, M. (1984). Andragogy in action. San
  Francisco Jossey-Bass.
• Mater, E. (2004). The art of moulage. Retrieved
  January 21, 2006 from http//www.dcmilitary.com
• Mort, T. C., Donahue, S. P. (2004). Debriefing
  The basics. In W. F. Dunn (Ed.),
• Simulators in critical care and beyond
  (pp. 76-83). Des Plaines, IL Society of
• Critical Care Medicine.
• Nehring, W .M., Ellis, W. E., Lashley, R. R.
  (2002). Human patient simulators in nursing
  education An overview. Simulation Gaming,
  32(2), 194-204.

21
References/Additional Readings

• Owen, H., Follows. V. (2006). Really good
  stuff GREAT simulation debriefing.
• Medical Education, 40(5), 488-489.
• Peters, V. A. M., Vissers, A. A. N. (2004). A
  simple classification model for
• debriefing simulation games. Simulation
  Gaming, 35(1), 70-84.
• Rall, M., Manser, T., Howard, S. K. (2000). Key
  elements of debriefing for simulator training.
  European Journal of Anaesthesiology, 17, 515-526.
• Rauen, C. A. (2004). Simulation as a teaching
  strategy for nursing education and orientation
  in cardiac surgery. Critical Care Nurse, 24(3),
  46-51.
• Rhodes, M. L., Curran, C. (2005). Use of the
  human patient simulator to teach
• clinical judgment skills in a
  baccalaureate nursing program. Computers,
• Informatics, Nursing, 23(5), 256-262.
• Rudolph, J. W., Simon, R., Dufresne, R. L.,
  Raemer, D. B. (2006). There's no such thing as
  "nonjudgmental" debriefing A theory and method
  for debriefing with good judgment. Simulation
  in Healthcare, 1(1), 49-55.
• Scherer, Y. K., Bruce, S. A., Graves, B. T.,
  Erdley, W. S. (2003). Acute care nurse
• practitioner education Enhancing
  performance through the use of clinical
• simulation. AACN Clinical Issues, 14(3),
  331-341.