6/12/20

Debriefing

Shelly Reed, PhD, DNP, APRN

I. Marlene Summers, MEd, MSS, MSNEd, RN
Kris Bouwhuis, MSRT, RRT, NPS, ACCS
Anne Kendrick, MSN, RN
Pamela Anderson, MSN, RN
LoraLynn Allen, MSNEd, RN, CHSE

Objectives

• Name three different debriefing structures

• Practice debriefing a health care scenario
• Demonstrate care of psychological safety

2 6/12/20 Add a footer

INACSL Standard of Best Practice: Debriefing

International Association for Clinical Simulation and Learning
(Dec 2016)
I

1. The debrief is facilitated by a person(s) competent in the process of

debriefing.
2. The debrief is conducted in an environment that is conducive to learning
and supports confidentiality, trust, open communication, self-analysis,
feedback, and reflection.
3. The debrief is facilitated by a person(s) who can devote enough
concentrated attention during the simulation to effectively debrief the
simulation-based experience.
4. The debrief is based on a theoretical framework for debriefing that is
structured in a purposeful way.
5. The debrief is congruent with the objectives and outcomes of the
simulation-based experience.

3 6/12/20 Add a footer

1
 6/12/20

Building the Foundation for the Debrief:

Learning Theories
Use simulation and or
program-based theories S4

Examples:
Kolb’s Experiential Learning Theory
Benner’s Novice to Expert
Caring theory
Jeffries’ Simulation Framework

4 6/12/20 Add a footer

Building the Foundation for the Debrief:

Learning Theories

5 6/12/20 Add a footer

Building the Foundation for the Debrief:

Learning Theories

6 6/12/20 Add a footer

2
 6/12/20

Building the Foundation for the Debrief:

Learning Theories

7 6/12/20 Add a footer

Building the Foundation for the Debrief:

Learning Theories
2005 Jeffries Theory 2012 Jeffries Theory

8 6/12/20 Add a footer

Building the foundation for the debrief:

Objectives
Intentional Debriefing

• Establish learning objectives S4

• Debriefing objectives are usually
congruent with those for the
simulation S5
• Plan and prepare in advance for
the debriefing, intentionally
focusing on aspects of the
simulation that will help meet
those objectives S4
9 6/12/20 Add a footer

3
 6/12/20

Setting the stage: Psychological Safety s2

ENVIRONMENT “Four C’s” Safety Contracts

• Comfortable • Always include
• Contained confidentiality
• Confidential “What happens in simulation
stays in simulation”
• Caring

10 6/12/20 Add a footer

WHO should be in the debrief

• Participants from the
simulation
• Facilitator S3
• Participant observers
• Others:
Clinical experts
Actors/standardized
patients from the sim
CAUTION: s2
Extra people
Others sticking their head
in/interrupting the debrief

11 6/12/20 Add a footer

Best practices to promote learning

Facilitator Demeanor Let the participants lead the

debriefing
Approachable, caring, positive, • Discuss, not lecture. Provide hints
focusing on strengths and cues, not answers
This doesn’t mean ignoring • Use silence. Pose questions that
incorrect actions. encourage the participants to
• How could you have done that come up with the answers. (Shut
differently? up and listen-8 second rule!)
• What could you do that might • Act as a guide, keeping the
produce a better outcome? discussion on core concepts

12 6/12/20 Add a footer

4
 6/12/20

More Ways to Promote Learning

Engage the debriefing participant

• Capture post-simulation energy. “How did it go?”
• Use open-ended questions
• Elicit participation from everyone
--Use participant names
--Asking direct questions pertaining to roles

13 6/12/20 Add a footer

Look for deeper meaning

• Examine actions: Identify performance gaps.

Recognize mistakes, and make plans for improvement.
Identify thoughts that led to both correct and
incorrect actions.
• Move beyond actions: Move from skills to other things
learned, such as prioritizing, critical thinking,
teamwork, and time management.
• Encourage transfer to future practice

14 6/12/20 Add a footer

Facilitate to the level of the learner

• Beginning learners: Simpler structures, i.e. plus/delta, simpler
objectives, questioning style. More facilitator input.
• Advanced learners: Can handle more complex debriefing,
enabling them to find more meaning. Less facilitator input.
Focus of debriefing:
• Team performance: Focus on interaction, communication
• Novice learner: Focus on things noticed, learned
• High-stakes debriefing: Use a rubric, more time, video-review
for confirmation
Group size: Different techniques needed based on group size
15 6/12/20 Add a footer

5
 6/12/20

Using a Debriefing Structure s4

Examples:
• Debriefing for Meaningful Learning (DML)
• Advocacy/Inquiry (DGJ)
• Plus/Delta
• PEARLS

16 6/12/20 Add a footer

Debriefing for Meaningful Learning (DML)

• Socratic questioning: • To explore complex ideas

•Guided reflection • To get to the truth of things
•Challenge assumptions • To open up issues and problems
•Reveal relationships
between thinking and • To uncover assumptions
actions • To analyze concepts
• To distinguish what we know from
what we don’t know
• To follow out logical implications of
thought or to control the discussion

17 6/12/20 Add a footer

Debriefing for Meaningful Learning (DML)

18 6/12/20 Add a footer

6
 6/12/20

19 6/12/20 Add a footer

Advocacy/Inquiry

• Data driven, state the facts, and ask

what happened I saw…
Advocacy-
• Inquire to learn, and only to learn st
1 Person
Observation
- Ask open-ended questions I think…
Insert Good
(No statements disguised as questions) Judgment

- Don’t use questions to cross examine I’m curious

Inquiry
- Avoid false praise about reasons
for learner
actions
- Ask for more information! o

20 6/12/20 Add a footer

21 6/12/20 Add a footer

7
 6/12/20

22 6/12/20 Add a footer

Plus (+) / Delta ( )

Plus: Things that are working
• Items that the individual or team wants to maintain and
build upon
Delta: Opportunities for improvement
• Things that can be changed so the individual or team may
be more effective
• Action oriented and begin with a verb
• Be specific
• Within the realm of possibility
• Should be reviewed and acted upon
• (Click on the link below for worksheet)
23
• https://fhop.ucsf.edu/sites/fhop.ucsf.edu/files/custom_download/ACPS_Plus_Delta_Template.pdf
6/12/20 Add a footer

24 6/12/20 Add a footer

8
 6/12/20

25 6/12/20 Add a footer

PEARLS Healthcare Debriefing Tool

26 6/12/20 Add a footer

27 6/12/20 Add a footer

9
 6/12/20

Audio Only

28 6/12/20 Add a footer

Managing Complex Debriefing Situations

•Participants who do not want to be there

•Participants who are dominating the conversation
•Handling unforeseen debriefing situations, i.e.
emotional events.

29 6/12/20 Add a footer

Managing Complex Debriefing Situations

•Governor without mandatory face mask when

visiting COVID-19 patients in a local hospital
•https://www.youtube.com/watch?v=82LPVgY_A8
s
30 6/12/20 Add a footer

10
 6/12/20

31 6/12/20 Add a footer

Managing Complex Debriefing Situations

•Participants who do not want to be there

•Participants who are dominating the conversation
•Handling unforeseen debriefing situations, i.e.
emotional events.

32 6/12/20 Add a footer

Use of debriefing adjuncts

Video Review Other

Evidence on use is mixed • Observation sheets

Can be a distractor • Concept maps
Make participants feel
unsafe • Worksheets (i.e.
Consider for: Debrief for Meaningful
Teamwork sims Learning, Plus/Delta)
Communication
High stakes

33 6/12/20 Add a footer

11
 6/12/20

Examples of post-debriefing activities to extend learning

• SBAR assignments, looking for patterns of recognition from

one assignment to the next
• Reflection journals, helping the facilitator know if learning
gaps still exist
• Reflection assignment, directed to specific
questions or topics
• Electronic health record assignments
• Self-assessments
• Repeat the scenario
34 6/12/20 Add a footer

Simulation program support

Maintaining consistency s4 Evaluation
• Providing facilitator Evaluation/assessment
training/updates: Keep needs to be broad, &
facilitators on the “same include
page”
• Learner(s) perception
• Choosing a theory, and/or (DES)
consistent debriefing
structure, to provide • Debriefer assessment s1
consistency between (DASH, OSAD, DML-Q)
different facilitator’s • Debriefing outcomes
debriefings (DELB)

35 6/12/20 Add a footer

References
:
• Alhaj Ali, A., & Musallam, E. (2018, March). Debriefing quality evaluation in nursing simulation-based education: An
integrative review. Clinical Simulation in Nursing, 16, 15-24. https://doi.org/10.1016/ j.ecns.2017.09.009.
• Arafeh, J. M. R., Hansen, S. S., & Nichols, A. (2010). Debriefing in simulated-based learning. Facilitating a reflective
discussion. Journal of Perinatal and Neonatal Nursing, 24(4), 302-309.
• Brackenreg, J. (2004). Issues in reflection and debriefing: How nurse educators structure experiential activities. Nurse
Education in Practice, 4, 264-270.
• Cheng, A., Eppich, W., Grant, V., Sherbino, J., Zendejas, B., & Crook, D. A. (2014). Debriefing for technology-enhanced
simulation: A systematic review and meta-analysis. Medical Education, 48, 657-666.
• Dreifuerst, K. T. (2015, May). Getting started with debriefing for meaningful learning. Clinical Simulation in Nursing, 11(5),
268-275. http://dx.doi.org/10.1016/j.ecns.2015.01.005.
• Dufrene, C. & Young. A. (2014). Successful debriefing-best methods to achieve positive learning outcomes: A literature
review. Nurse Education Today, 34, 372-376.
• Ganley, B. J. and Linnard-Palmer, L. (2012). Academic safety during nursing simulation: perceptions of nursing students and
faculty. Clinical Simulation in Nursing, 8(2), e49-e57.
• INACSL Standards Committee (2016). INACSL standards of best practice: Simulation Debriefing. Clinical Simulation in
Nursing, 12(S), S21-S25. http://dx.doi.org/10.1016/ j.ecns.2016.09.008.
• Kolb, A. Y., & Kolb, D. A. (2011). What is experiential learning? Hay Resources Direct. Available from
www.learningfromexperience.com

36 6/12/20 Add a footer

12
 6/12/20

References
• Levett-Jones, T., & Lapkin, S. (2014). A systematic review of the effectiveness of simulation debriefing in health professional
education. Nurse Education Today, 34, e58-e63.
• National League of Nursing (NLN). (2015). NLN Vision Series: Debriefing Across the Curriculum. Retrieved from
http://www.nln.org/docs/default-source/about/nln-vision-series-%28position-statements%29/nln-vision-debriefing-across-the-
curriculum.pdf?sfvrsn=0
• Neill, M. A. & Wotton, K. (2011). High-fidelity simulation debriefing in nursing education: A literature review. Clinical Simulation in
Nursing, 7(5), e161-e168.
• Reed, S. J. (2015). Written debriefing: Evaluating the impact of the addition of a written component when debriefing simulations.
Nurse Education in Practice, 15(6) 543-548. Doi: 10.1016/j.nepr.2015.07.011
• Reed, S. J. (2016). Identifying learning acquired during debriefing. (Doctoral dissertation). UNLV Theses, Dissertations, Professional
Papers, and Capstones. 2742. Retrieved from http://digitalscholarship.unlv.edu/thesesdissertations/2724.
• Waznonis, A. R. (2014). Methods and evaluations for simulation debriefing in nursing education. Journal of Nursing Education, 53(8),
459-465.
• Willard, R. (2014). Structured versus nonstructured debriefing: Finding the right approach in undergraduate nursing simulation.
(Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses database. (UMI No. 3620381)
• Zigmont, J. J., Kappus, L. J., & Sudkioff, S. N. (2011). Theoretical foundations of learning through simulation. Seminars in
Perinatology, 35, 2.

37 6/12/20 Add a footer

Discussion Board

38 6/12/20 Add a footer

13