Debriefing Maria Overstreet, PhD (c), RN, CCNS

Seven Objectives for Today! Importance of debriefing, historical perspective. Educational theory supporting debriefing. Components of debriefing nurse educators use. Various methods of debriefing. When to use which method. How do you determine which method works best? Learn while having fun.

History Term Debriefing –What does it mean to you? Military Psychology Nursing

History –WWII Brigadier General Marshall –CISD (Critical Incident Stress Debriefing) Mitchell –PD (Psychological Debriefing) Dyregrov –Hall Stress in nurses’ daily work life: stress debriefing

Theory –educational literature supports need to debrief following an experiential learning exercise –Bloom’s Taxonomy? Domains: Cognitive, Psychomotor, Affective

Experiential Learning & Reflective Practice Dewey (1938) –Interaction –Continuity Kolb (1984) –Experiential learning process Concrete Experience, Reflective Observation, Abstract Conceptualization, Active Experimentation Schön (1987) –Reflective practice

Kolb’s Experiential Learning Model Overlaid with Nursing Clinical Simulation Debriefing (by Overstreet 2008) CE Knowledge, skill, attitude, experience during simulation RO Debriefing process Rich discussion of events and how to manage differently or how managed well AC Debriefing Process Able to view situation in various contexts: different disease processes or patient response AE Knowledge, skill, attitude, experience during simulation

Reflective Practice Schön’s theory of reflective practice (1987) –Reflection in action –Reflection on action

Rudolph, Simon, Dufresne, & Raemer (2006) What is good judgment? –Judgment, bad judgment, good judgment Experienced opinion delivered in a respectful manner Advocacy & Inquiry –Conversational technique Good judgment + genuine curiosity Double loop learning –Argyris & Schön (1978) –FramesActionsResults

Medical Literature Gaba, et al. (2001): Anesthesia Crisis Resource Mgmt Dismukes, et al. (2006): Role of facilitator Bond, et al. (2004): Mistakes can cause reflection Savoldelli, et al. (2006): Value of debriefing

Nursing Literature –Definition –Essential components Lasater Baldwin Jefferies Johnson-Russell –NLN, Laerdal 3 year study Jefferies –Most important design feature of simulations was debriefing Decker –Philosophical underpinnings –Tables to offer simplicity to novice

Methods to Use Various ways to debrief: –Plus/Delta –Facilitator –Lecture –Psychological –Good Judgment –Link to real life experiences

Which method? Which method matches content of simulation exercise and goals? What pieces of the simulation do you desire to bring forth: ethics, culture, value, moral, psychomotor skill, knowledge, or emotion? How do you expect the student will respond? Determine which method works best for you as the educator…most of all Be flexible!