MCN Nursing Simulation Laboratory Debriefing Guidelines
Definitions:
- “…a reflective thinking session in which the students and faculty examine what happened and what was learned.” “…provides learners with an opportunity to assess their actions, decisions, communications, and ability to deal with the unexpected in the simulation.” (Jeffries, 2005)
- “…a process in which people who have had an experience are led through a purposive discussion of that experience. (Hertel & Millis, 2002)
Role of the student---active not passive; are focus of debriefing; need to critically analyze actions.
Role of Debriefer: facilitator not lecturer; resource person; structures debriefing in an organized way; remembers to refer back to scenario objectives.
Stage I: Clear the air and set the stage for discussion;
emotional release; feelings; facts (OSHU)
- Guiding Principles:
Introduce debriefing experience & establishes ground rules:
(1) Establish psychological safety:
“This is a safe environment “
“Tell us the truth”
“In the debriefing, everyone is treated respectfully…”
“Nobody is judging you.” “No grades.” “No failing.”
(Need to hear this over and over again…)
“This is YOUR time to talk about this experience.”
“What happens in the Lab stays in the Lab.”
(2) Other discussion:
“How did you feel during the scenario?”
“How do you feel now?”or “Talk to me about how this experience
made you feel.”
“What do you think happened?”
“What did you see happening?”
Stage 2: Construct understanding: Examine what happened; uncover the participants thinking, and correct misunderstandings (OSHU)
- Guiding Principles:
- Encourage participants to take initiative in the discussion; Remember: Talk less and facilitate more; try to only ask questions!!
- Provoke interesting and engaging discussions that foster reflective practice; Encourage the participants to talk to each other.
- Correct a LIMITED number of errors; errors are discussable, let the learners identify own mistakes when possible (maybe a playback of the video will help them see what really happened); no excessive criticism or negative feedback
- Stress key educational points
- Reinforce good practice
- Identify performance gaps and help close them; don’t humiliate a team member or fixate on one area of the scenario that was a problem.
RESPECTFULLY insert your expertise but not right away -- remember you are a resource.
Stage 3: Summary/Reflection: Participants describe how new knowledge and understanding will be applied to practice; seek commitment for improvement (OHSU)
Tanner, CA (2006),Thinking like a nurse: A research-based model of clinical judgment, Journal of Nursing Education, 45(6), 204-211.
Noticing
(Playback of video may help student see what really happened)
“What did you notice when you walked in the room?” (BIG PICTURE: Assessment data, environment, family/ patient dynamics, treatment plan…)
Recognizing a change in the clinical situation that demands attention.
Interpreting — the Learner’s Thinking(Tanner)
Purpose: To help the student think deeper: use a curiosity-based approach; explore your hunches about the participants’ thinking; ask questions to help the participants think more deeply about the issues---
Acknowledge: A statement about the participant’s action or behavior
(eg: “As the nurse, you took action and began to prepare the
medication…”)
Exploration: A statement about the participants thinking at the time of the behavior and or action
(eg: “What were your thoughts about the priorities of this situation?”)
Responding(Tanner)
Purpose: Facilitate discussion. Discuss positives first, then negatives. Be prepared for relevant detours. May need to integrate unplanned learning.
“How do you think it went?”
“What did you do well?” or “What went well?”
“What didn’t go well?” or “What was not done?”
Reflecting (Tanner)
Purpose: Discussion of how new knowledge and understanding will be applied to practice
Nursing Simulation Laboratory Debriefing Guide
Noticing(Tanner)
(Playback of video may help student see what really happened)
“What did you notice when you walked in the room?” (BIG PICTURE: Assessment data, environment, family/ patient dynamics, treatment plan…)
“What is the patient experiencing?”
“What did you/the team notice about the nursing team?”
“How did you/they approach the patient/problem?”
“How did the communication go?”
“What strategies did you/they use?”
“What did you/they do during this encounter?”
“What was your/their plan?” “Did the plan change?”
“What were your/their priorities?”
“How did you/they decide priorities?”
“Could the nurses have handled any aspects of the simulation differently?”
Interpreting — the Learner’s Thinking(Acknowledge and Explore) (Tanner)
“As the nurse, I noticed that you …”
“What were your thoughts about the priorities of this point?”
“What information was being used?”
“Did you need anything that was not there?”
“Talk to me about how your personal values and beliefs influenced your actions during this experience.”
“What was your main goal during this simulation?”
“Describe the objectives you were able to achieve.”
“Which ones were you unable to achieve…if any?”
“What did the team feel was the primary nursing diagnosis?”
“What were the key assessments and interventions?”
“Talk to me about the problem your patient was having.”
“Did you have the knowledge and skills to meet objectives?”
- When you question if student knows something or if a student made a mistake in the scenario: SAY:
“I’m concerned…” or I’m confused…talk with me about what you
were thinking…”
“Talk about your rationale for ……”
“Tell me what influenced your actions during the scenario.”
“What would you do differently next time?”
Responding(Tanner)
“How do you think it went?”
“What did you do well?” or “What went well?”
“What didn’t go well?” or “What was not done?”
“How do you rate your communication between team members?”
“Would you have done the same thing as ______?”
“Talk to me about how satisfied you are with the actions you initiatedduring this scenario.”
“Were you satisfied with your ability to work through the simulation?”
“Is there anything else you would like to discuss?”
Reflecting (Tanner)
“How would you use this case to help guide your future practice?”
“If you were able to do this again, how could you have handled the situation differently?”
“What will you never forget because of this experience?”
Developed with use of notes from Jeffries, B-J, OSHU Workshop---including Tanner, NLN/Laerdal and Decker.
dc 4/11; cjm 8/11
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