Debriefing Made Easy

1. 1 Debriefing Made Easy HPSN �08 Judy Johnson-Russell Ed.D., RN METI Clinical Educator Professor Emerita Texas Woman�s University Dallas, TX

2. 2 Objectives Discuss the Goals of Debriefing Discuss the Importance of Debriefing Describe Various Ways to Debrief Discuss Techniques of Debriefing Describe the Process of Debriefing

3. 3 Goals of Debriefing Recognize and release emotions built up during simulation (Fritzsche, Leonard, Boscia, & Anderson, 2004). Safe place to express feelings Mistakes part of learning process (Henneman & Cunningham, 2005).

4. 4 Goals of Debriefing Reinforce Objectives of Simulated Clinical Experience (SCE) Students 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. 5 Goals of Debriefing Student questions can be answered, student thinking can be clarified, teaching points can be emphasized (Fritzsche, Leonard, Boscia, & Anderson, 2004; Jeffries, 2005). Published/standardized guidelines can be reviewed (Owen & Follows, 2006).

6. 6 Goals of Debriefing Clarify Information Possible for students to manipulate the data in such a way that they distort it and make it fit into their previous learning. Through the debriefing process, faculty can insure that new learning is processed correctly (Chiodo & Flaim, 1993). Connect theory to practice

7. 7 Goals of Debriefing Enhance Critical Thinking and Problem Solving Advantageous to compare different perspectives and a joint analysis. This increases student understanding (Peters & Vissers, 2004). Safe place to discuss without constraints of time (Mort & Donahue, 2004) and pressure of being in the simulated clinical experience Identify resources (IOM recommendation) Encourages Collaboration and Communication

8. 8 Goals of Debriefing Reflective learning (Mort & Donahue, 2004). Reflection should relate to objectives Self-assessment Why acted as they did, correct, differently Individually what do they need to work on? Feedback from peers (Henneman & Cunningham, 2005 Focus on performance, not performer

9. 9 Goals of Debriefing Link to the �Real World� Link what has been learned in simulated setting to �real world� (Chiodo & Flaim, 1993; Fritzsche, Leonard, Boscia, & Anderson, 2004; Peter & Vissers, 2004). How didactic and theory apply to patient Acknowledge the unreality, link to real patients, real situations

10. 10 Simulation and Debriefing Assists with meeting the needs of adult learners Assists with meeting the needs of multiple learning styles Are learner directed rather than faculty directed

11. 11 Ways to Debrief Number involved, participants and observers Separate, together Verbal, Written, Presentations, Prevent peers not involved from being critical and embarrassing those involved. If with participants and observers, need ground rules to make it a safe learning environment. Time available Video available Number of Faculty Availability of Facilities

12. 12 Professional Learning Environment

13. 13 Debriefing with Video Students must know in advance that they are being videotaped (Hravnak, Tuite, & Baldisseri, 2005), how it will be used and when it will be erased Signed permissions (Scherer, Bruce, Graves, & Erdley, 2003). Should erase tape after the debriefing (Hravnak, Tuite, & Baldisseri, 2005). If kept for viewing by others, permission needs to be provided by students (Hravnak, Tuite, & Baldisseri, 2005).

14. 14 Debriefing with Video Should be used with faculty led discussion/debriefing. Students and faculty review the videotape and collaboratively critique the student�s decision making and the outcomes (Hravnak, Tuite, & Baldisseri, 2005). Provides psychomotor and visual learning, plus reflection, helps students increase competence (Graling & Rusynko, 2004).

15. 15 Debriefing with Video Reminds students of specifics of SCE events. Event management and decision making at key crisis points can be discussed. Counter More appropriate actions can be suggested and theory to support the actions taken or not taken can be discussed. (Hravnak, Tuite, & Baldisseri, 2005)

16. 16 Process of Debriefing Introduction Personal Reactions Discussion of Events Summary

17. 17 Introduction Prepares students to actively analyze and evaluate self and simulation activities. Communicate expectations Describe faculty role Facilitation vs evaluator Confidentiality Signed statement Safe environment to express feelings and ask questions Review objectives of the SCE

18. 18 Personal Reactions Students 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 Their responses can guide the discussion of events Ensure that all in small groups have the opportunity to respond

19. 19 Discussion of Events Encourage students to continually analyze the events in depth and their feelings and reactions to them. Students learn and remember more when they participate actively and make their own analyses (Duvall & Wicklund, 1972). How familiar were you with the patient�s condition, treatments, and complications prior to the SCE?

20. 20 Discussion of Events What happened? What did they do as a team or individually? What was the outcome? What would they do differently next time, individually, as a team? What additional information, knowledge, skills, etc. do they think were/are needed in the situation, for the future?

21. 21 Discussion of Events View videotape whenever appropriate Or continue with questions from the METI PNCI Debriefing Guide. 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, team members. Discuss errors with protocols/guidelines

22. 22 Discussion of Events Have them give specific examples of where they prioritized the needs of he patient effectively Ask if there were any techniques, interventions, or medications they were not familiar with. Ask what did they learn new from the SCE. Have them give example of information they received in class or their readings that became clearer to them during the SCE. Ask what individually and as a group they feel they need to work on.

23. 23 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 work on. Could be done by faculty or by asking open-ended questions of the students End on a positive note In summary, these are the things you identified as going well�.

24. 24 Summary 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 students for participating in both the SCE and debriefing Written Evaluation

25. 25 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. 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. 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.

26. 26 References/Additional Readings 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. 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. 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. 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.