1. Transforming Healthcare Education Through the Art of Facilitation
Rebecca C. Threatt, DNP, RN, CHSE
12th annual OHWC Simulation Conference
May 22, 2018

2. Disclosures
…No!

3. Objectives
Discuss the INACSL Standards of Best Practice for Simulation Debriefing.
Develop an understanding of INACSL Standards of Best Practice for Simulation Facilitation.
Demonstrate the art of facilitation and simulation best practice.

4. INACSL Standards of Best Practice: Simulation Debriefing
All simulation-based experiences include a planned debriefing session aimed at improving future performance.
Criteria:
The debrief is facilitated by a person(s) competent in the process of debriefing.
The debrief is conducted in an environment that is conducive to learning and supports confidentiality, trust, open communication, self-analysis, feedback, and reflection.
The debrief is facilitated by a person(s) who can devote enough concentrated attention during the simulation to effectively debrief the simulation-based experience.
The debrief is based on a theoretical frame-work for debriefing that is structured in a purposeful way.

5. Debriefing: Theoretical Frameworks
Debriefing for Meaningful Learning (Dreifuerst, 2015)
Debriefing with Good Judgment (Rudolph, Simon, Dufresne, & Raemer, 2006).
Promoting Excellence and Reflective Learning in Simulation (PEARLS)
Debriefing Assessment for Simulation in Healthcare (DASH)
Plus/Delta or +/
Others …
DML
DWGJ
PEARLS: Eppich and Cheng3 have published an excellent approach to debriefing that reviews many of the key steps a novice simulation educator should aim to follow. They have called it the PEARLS approach (Promoting Excellence and Reflective Learning in Simulation). 
DASH
Plus/delta

6. INACSL Standards of Best Practice: Simulation Facilitation
Facilitation methods are varied, and use of specific method is dependent on the learning needs of the participants and the expected outcomes. A facilitator assumes responsibility and oversight for managing the entire simulation-based experience.
Criteria:
Effective facilitation requires a facilitator who has specific skills and knowledge in simulation pedagogy
The facilitative approach is appropriate to the level of learning, experience, and competency of the participants
Facilitation methods before the simulation-based experience include preparatory activities and a prebriefing to prepare participants for the simulation-based experience.
Facilitation methods during a simulation-based experience involve the delivery of cues (predetermined and/or unplanned) aimed to assist participants in achieving expected outcomes.
Facilitation after and beyond the simulation-based experience aims to support participants in achieving expected outcomes.

7. Facilitator
“Guide on the side” and embrace a learner-centered approach (van Soeren et al., 2011).
Allow participants to do most of the talking (Dieckmann et al., 2009).
Facilitator characteristics:
Students identified: personality, teaching ability, evaluation, nursing competence, interpersonal relationships, and realism (Parsh, 2010).
Simulation facilitators identified: evaluation, nursing competence, personality, teaching ability, technological skills, designing scenarios, and manipulating equipment (Parsh, 2010).
Jefferies (2016): personality, nursing competence, interpersonal relationships, technological skills, attitude, attributes, roles, responsibilities, values, self-awareness, teaching ability.

8. Facilitate at the learners level
Low
Intermediate
High
Facilitator Heavily Directs the Debriefing:
Facilitator Assists:
Facilitator Guides:
Confirming Statements
Agreeing
Recapping
Reinforce Ideas
Echoing
Nonverbal Cues: Nodding, Eye Contact, and Leaning Forward
Rephrasing Statements
Asking Questions
“Going Around the Room” Approach
Learners Capable of Leading the Discussion
Participants Lead the Debriefing
Pausing for Reflection
Open Ended Questions
Phrases Utilized
Silent
Original Reference by Dismukes, R., & Simth J. (2000). Facilitation and debriefing in aviation training and operations. Aldershot, UK: Ashgate.
Fanning, R. M. & Gaba, D. M. (2007). The role of debriefing in simulation- based learning. Society for Simulation in Healthcare, 2, doi: /SIH.0b)13e

9. Demonstrating the art of facilitation and simulation best practice.
Scenario: Cultural Care
Pre brief: Too little – too much, what is enough?
Debrief: two ways!
Five Volunteer Participants
Three “students”
Patient
Patient’s family member
Scenario: Cultural Care
Complexity – Simple to Complex
1. For the beginning student, the focus is on recognizing and understanding the cultural implications in the scenario.
2. For the advanced students, the goal is to implement cultural consideration in the care they provide. For the student to understand their own cultural values that might come into play

10. Out of the Seat and into the Brain

11. Pre-brief Scenario role assignments Primary Nurse Secondary Nurse
Recorder
Patient
Patient’s daughter

12. Scenario Objectives Knowledge:
The Learner will implement cultural consideration in the care they provide.
Skills
The Learner will demonstrate the correct method of obtaining surgical consent.
Attitudes
The Learner will understand their own cultural values that might come into play.
Consider the level of the learner for the scenario objectives.
Objectives need to be measurable
Outcomes are defined as measurable results of the participants’ progress toward meeting a set of objectives. They demonstrate a change in knowledge, skills, and/or attitudes. Remember Kirkpatrick Model: Reaction, learning, behavior, results … want a change in behavior with positive results!

13. Cultural Care Mr. Negusi Teferra with daughter Ribka Negusi
This is Mr. Negusi Teferra, who was admitted yesterday complaining of urinary retention and a headache “on and off” for a week. The admitting physician, Dr. Montgomery, diagnosed him with Benign Prostatic Hyperplasia (BPH). Dr. Montgomery has spoken to patient about possible TURP surgery and patient has given oral consent. The patient needs to sign the consent for surgery. Patient is cooperative, alert and orientated X4. He is well educated and is a retired Professor. This hospitalization occurred during Mr. Teferra’s first visit to the US from Ethiopia. He has been here for one month visiting his youngest daughter. His daughter is a health care professional and also teaches at an Urban Community College.
His vitals have been stable since admission. He has a Normal Saline infusing in the primary with IV antibiotic in secondary on the right for arm.

14. Labs

15. Test Results
Transurethral ultrasound Chest x-ray ECG

16. Debriefing: Lecture vs. Facilitation

17. Scenario Objectives Knowledge:
The Learner will implement cultural consideration in the care they provide.
Skills
The Learner will demonstrate the correct method of obtaining surgical consent.
Attitudes
The Learner will understand their own cultural values that might come into play.
Consider the level of the learner for the scenario objectives.
Objectives need to be measurable
Outcomes are defined as measurable results of the participants’ progress toward meeting a set of objectives. They demonstrate a change in knowledge, skills, and/or attitudes. Remember Kirkpatrick Model: Reaction, learning, behavior, results … want a change in behavior with positive results!

18. Cultural Care Mr. Negusi Teferra with daughter Ribka Negusi
This is Mr. Negusi Teferra, who was admitted yesterday complaining of urinary retention and a headache “on and off” for a week. The admitting physician, Dr. Montgomery, diagnosed him with Benign Prostatic Hyperplasia (BPH). Dr. Montgomery has spoken to patient about possible TURP surgery and patient has given oral consent. The patient needs to sign the consent for surgery. Patient is cooperative, alert and orientated X4. He is well educated and is a retired Professor. This hospitalization occurred during Mr. Teferra’s first visit to the US from Ethiopia. He has been here for one month visiting his youngest daughter. His daughter is a health care professional and also teaches at an Urban Community College.
His vitals have been stable since admission. He has a Normal Saline infusing in the primary with IV antibiotic in secondary on the right for arm.

19. Facilitator’s Role: Keep things on track
Ask clear and direct questions
Step in and change the subject if participants begin to raise voice or get off track
Get team members to turn complaints into positive actions
If participant is stuck on complaint, ask “what do we do about that?”
If feedback is needed for individual participant, deal with it one-on- one privately!

20. Main function of debriefing
Provides a summary of events and identifies main objectives of the scenario for reflection.
Interactive, bi-directional and reflective nature of discussion.
Reflective Practice or Thinking (NLN, 2015).
Learners explore, question, and reorder the processes in which they act, understand, think, believe, feel, and value
Assessment of relevance
Define rationale for actions taken
The how, what, and why of thinking discovered during a learner- centered crucial conversation
NLN. (2015). Debriefing across the curriculum: A living document from the National League for Nursing. VisionSeries. NLN Board of Governors in Collaboration with INACSL. Retrieved from

22. Take a-ways and questions …
Rebecca C. Threatt:

23. References
Chronister C. & Brown D. (2012). Comparison of simulation debriefing methods. Clinical Simulation in Nursing, 8(7), e281-e288. Dreifuerst, K. T. (2015). Getting started with debriefing for meaningful learning. Clinical Simulation in Nursing, 11, International Nurses Association for Simulation and Clinical Learning. (2016). Standards of best practice: Simulation. Clinical Simulation in Nursing, 12, s5-s50. Jeffries, P. R. & National League for Nursing. (2016). The NLN Jeffries simulation theory. Philadelphia, PA: Wolters Kluwer. Jeffries, P. R. (2012). Simulation in nursing education. New York, NY: National League for Nursing 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. Ulrich, B. & Mancini, B. (2014). Mastering simulation: A handbook for success. Indianapolis, IN: Sigma Theta Tau International. University of South Dakota School of Health Sciences. (2017). Simulation Scenarios. Retrieved from scenarios