Transcript Debriefing - TN Simulation Alliance

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
• 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)
AE
Knowledge, skill,
attitude, experience
during simulation
AC
Debriefing Process
Able to view situation in
various contexts:
different disease
processes or patient
response
CE
Knowledge, skill,
attitude, experience
during simulation
RO
Debriefing process
Rich discussion of
events and how to
manage differently or
how managed well
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)
– Frames
Actions
Results
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!