1. Debriefing for Emotions vs Education: When and Why Julie Arafeh MSN, RN

3. Objectives Compare the goals of debriefing for psychological support to that of debriefing for human and system performance Describe how a series of performance-based questions can be used to objectively guide debriefing Review how performance-based questions can be used in difficult debriefing situations

4. What is debriefing?

5. Debriefing Definitions Officially question someone about a job or experience Interrogate after an event to obtain useful information Carefully review upon completion Merriam-Webster

6. Types of Debriefing Psychological debriefing beneficial for emotional release after a difficult experience Human and system performance debriefing goal is to objectively review events often comparing performance to national or hospital standards in order to improve or maintain performance ▫System issues that impede performance are noted and addressed

7. Feedback vs Debriefing Feedback – review or critique, usually instructor dominant Debriefing – instructor facilitates discussion among learners J Perinat Neonat Nurs 2010; Vol. 24( 4):, pp. 302–309

8. Role of Debriefing Occurs immediately after scenario Confidential discussion Private location Capture system issues, near misses

9. Role of Debriefing Where the learning occurs Experiential Learning (Kolb)  Experience in action (simulation)  Observation and reflection (debriefing)  Theorizing (debriefing)  Experimentation and change (simulation)

10. What is a good debriefing?

11. In a good debriefing Learning objectives are discussed in a constructive, concise manner Remains learner focused/driven Well organized Identifies gaps in knowledge, performance Engages all learners regardless of whether or not they were involved with actual simulation

12. Tips for Successful Debriefing

13. Start with Learning Objectives Cognitive What you want learners to know Technical What you want learners to be able to do Behavioral ▫Team skills – communication, role delegation, leadership

14. Start with Learning Objectives Relevant to learners Maximum 3-5 learning objectives per scenario Keep scenarios short in duration in order to focus on learning objectives ▫Facilitates thorough review of scenario Measureable

15. Learning Objectives Understand NRP algorithm ▫Identify steps in NRP algorithm based on HR and time Utilize good communication skills ▫Communicate with team using directed, closed loop communications

16. Learning Objectives Bag mask ventilate a patient ▫Effectively ventilate patient as demonstrated by good seal, correct pressures and rate Assume the leadership role ▫Demonstrate good leadership through continued reassessment of patient/situation, invitation of input from team, maintain big picture perspective

17. Develop A Debriefing Checklist List of critical behaviors in the scenario ▫Completed during scenario by debriefer, other simulation faculty or learner not in scenario Based on learning objectives, policies and procedures, algorithm

18. Sample Checklist ActionYes/NoComments Establish unresponsiveness Call for OB provider, Code team, Peds team Lower head of bed, begin compressions

19. Debriefing Checklist: Metrics Add measurements ▫Time ▫Number of occurrences Metric standard or Goal ▫Give to learners prior to scenario ▫Compare performance to goal/standard

20. Sample Checklist (cont) ActionYes/NoComments Lower head of bed, begin compressions Time confirmed unresponsive to chest compressions Unresp confirmed: Compressions started: Time unresponsiveness to defibrillation Defibrillation: Time of call to code team to arrival Code team called: Arrival:

21. Debriefing Questions Open-ended questions based on learning objectives Designed to facilitate discussion Used during debriefing as an aid Organized by appearance in scenario

22. Learning Objectives for Maternal Arrest Cognitive ▫List common “H’s and T’s” of pregnancy Technical ▫Perform chest compression mid-sternum at rate of 100/min with depth of 2 inches Behavioral ▫First responder will assign roles to other responders as they arrive on scene

23. Debriefing Question Organization Technical ▫How are the compressions that are being delivered at this time? Behavioral ▫What roles are the first responders in? ▫How did the role assignment hinder/facilitate following the algorithm?

24. Debriefing Question Organization Cognitive ▫What are the most common H’s and T’s in pregnancy? ▫What is the differential diagnosis in this case?

25. Questions When You are Stuck... What just happened? What circumstances led to that? What can be done to ▫facilitate that positive event? ▫prevent that negative event?

26. Use the Video Be sure video captures learning objectives during scenario Stop video for ▫Learning objectives ▫Unexpected actions/occurrence Particularly good for discussion of behavioral objectives

27. Large Range of Learner Experience Questions for new staff ▫What are the signs that an OB patient is decompensating? ▫What would trigger a call for help?

28. Large Range of Learner Experience Questions for more experienced staff ▫What is the best way to organize the room for this situation? ▫ Who do you need in the room? What do you want them to do? ▫What equipment do you need? ▫What do you need to prepare if the situation worsens?

29. Problem with Scenario or Equipment Acknowledge there was a problem and move to a question If it is realistic ▫Could this happen? ▫Has this happened to anyone?

30. Perfect Performance in Scenario Stop video when tasks completed efficiently and effectively ▫What has been accomplished so far ▫How does this compare to the algorithm/policy? ▫What helped the team? ▫What was good about the communication/ leadership/ role delegation?

31. No/Few Learning Objectives Met Stop video BEFORE a key procedure or assessment or at beginning of algorithm ▫Have learners discuss what should happen based on patient status

32. No Learning Objectives Met Watch video, stopping frequently to determine what happened to deter team ▫OFTEN behavioral issues like role delegation, lack of a leader, communication issues or system issues are evident

33. References Sawyer TL, et al. Adaption of the US Army's After-Action Review for Simulation Debriefing in Healthcare. Sim Healthc 2013;8:388-397. Edelson DP, et al. Improving in-hospital cardiac arrest process and outcomes with performance debriefing. Arch intern med. May 26, 2008;168(10):1063-1069. McGreevy JM, et al. Briefing and debriefing in the operating room using fighter pilot crew resource management. J Am Coll Surg. Jul 2007;205(1):169-176.

34. References Dismukes RK, et al. So many roads: facilitated debriefing in healthcare. Simul Healthc. Spring 2006;1(1):23-25. Bartone PT, et al. Event-oriented Debriefing Following Military Operations: What Every Leader Should Know. In: 29218 USAMRU, ed. Maryland: USAMRU-E;1995. McDonnell LJK, et al. Facilitating LOS Debriefings: A training manual (NASA Technical Memorandum 112192. In: Administration NAaS, ed. Moffett Field, CA 1997. Division MOBFCS. Apollo 13 Technical Crew Debriefing. In: Administration NAaS, ed. Houston Texas 1970:198.

35. jarafeh@stanford.edu