Simulation Debriefing Isn’t Always at the End! Westmoreland County Community College, Youngwood, Pa Ruth E. Irwin, MSN,

1. Simulation Debriefing Isn’t Always at the End! Westmoreland County Community College, Youngwood, Pa Ruth E. Irwin, MSN, RN Pauline Freedberg, MSN, RN CarieShedlock, MSN, RN Kathleen A. Malloy, PhD, RN

2. Disclosure The presenters have no affiliation or financial interest in any of the content or equipment referred to in this presentation. WCCC. 2012

3. Objectives • Recognize that debriefing during simulation does not always have to be at the end. • List the benefits of using in-simulation debriefing during a student nurse simulation scenario. • Describe a teaching strategy designed to improve learning outcomes and decrease stress and anxiety during a student nurse simulation scenario.

4. Quick Survey … • When you first started learning about Simulation what were you told? • What education did you receive? • What did you hear about debriefing? • Did you get enough information on debriefing? • The Simulation Model - a review

5. (Jeffries & Rizzolo, 2006)

6. Faculty Role of Simulation Facilitator • Simulations are student centered • Experiential Learning Experience

7. Faculty as Simulation Facilitator Debriefing – the activity that follows a simulation experience led by a facilitator wherein feedback is provided on the simulation participants’ performance while positive aspects of the completed simulation are discussed and reflective thinking encouraged (NLN-SIRC, 2010) Simulation Innovation Resource Center (SIRC)

8. Faculty as Simulation Facilitator Guided Reflection – the process encouraged by the instructor during debriefing that reinforces the critical aspects of the experience and encourages insightful learning allowing the participant to link theory with practice and research (NLN-SIRC, 2010).

9. Key to Success! • Faculty must: • be comfortable with the topic • be prepared • comfortable with self • acceptance of deviations from the planned scenario • Equal Time spent in the Simulation Scenario and Debriefing

10. Role of Facilitator Steps in the Debriefing Process Role of Evaluator Testing purposes Observer • Provide Support • Cues • ask questions • what if? • Teaching Simulation • Guide Debriefing @ end or during phases of the simulation

11. Reflection • Reflection is a Conscious, Self- Evaluation that Connects Theory to Clinical • It is the opportunity to self-assess their actions, decisions, communication, and deal with the unexpected.

12. Prep Questions to lead and focuson objectives of the simulation • Guided by Carper’s Fundamental Patterns of Knowing in Nursing: • Empirical • Aesthetic • Personal • Ethical (Jeffries, 2007; Johns, 1995)

13. Empirical What knowledge did you have that assisted you in this scenario? Aesthetic What was a priority for you? • Patient Problem • Goal for simulation Personal How did you feel in this scenario? What factors were influencing you? Ethics What personal values or beliefs influenced your actions today?

14. Simulation Debriefing Isn’t Always at the End!

15. SIM MAN is Here…Now What?

16. Apply Theory to Clinical Practice

17. Embrace the Monster!

18. Boy, Was I Wrong! “Causes more frustration than is helpful.” “Reinforces student inadequacies.” “3 hours of lecture is not enough time for us to know what to do in a situation simulating real life.” “Showed our deficient knowledge.” “Watching students not know what to do is not very helpful.”

19. How Do You Eat an Elephant?

20. One Bite At A Time

21. Less Stress and Anxiety? • “I didn’t feel threatened or scared because I had the help of the entire class. It was conducive to learning because when you get nervous, you forget things.” • “Better learning experience when instructor is involved and asking questions, like, what are you thinking you should do now?” • “Liked the group collaboration, it was less stressful and more conducive to learning.” • “I think it was a really good learning experience because it was nice we were not put on the spot, especially when having to think about what needed to be done next.”

22. Taming the Lion

23. Debriefing: Making Thinking and Learning Skills Visible http://www.teachingexpertise.com/e-bulletins/effective-debriefing-making-thinking-and-learning-skills-visible-7895

24. Reflective Debriefing: Design and Benefits • Prebriefing • “Redoing a skill” • Facilitator demonstration • “Rescue” • Teachable moments • “Expect the unexpected”

25. Example: Prebriefing DVD clip from the beginning of Shock Sim Scenario 1/12; Shows PreSim Setup – about 4 minutes.

26. Reflective Debriefing: Design and Benefits • Prebriefing • “Redoing a skill” • Facilitator demonstration • “Rescue” • Teachable moments • “Expect the unexpected”

28. Reflective Debriefing: Design and Benefits • Prebriefing • “Redoing a skill” • Facilitator demonstration • “Rescue” • Teachable moments • “Expect the unexpected”

29. In Summary: GENERAL PRINCIPLES TO FOLLOW IN DEBRIEFING : • Debriefing should be learner-centric • Build a challenging yet safe environment • Debriefing points are derived through setting appropriate objectives which drive the process • If using in-scenario debriefing spend time up front explaining what will occur • Debriefing should enhance learning • Debriefing should increase understanding • Identifies best practices • Promotes safe, quality patient care • Promotes knowledge transfer (Material supported by International Nursing Association for Clinical Simulation and Learning. Published by Elsevier)

30. If used for evaluation,Debriefing should… • Follow standardized format and scoring and be appropriate to the level of fidelity (low to high) in order to achieve participant outcomes • Have predetermined parameters for terminating the scenario before its completion • Should be held in familiar environment for participants • Scenario should be achievable within appropriate time frame • Incorporate evidence-based practice • Students should have been previously presented/tested for content

31. Nursing Skill Development and Clinical Judgment Model

32. FACULTY OBJECTIVES IN DEBRIEFING • Be Real • Correct a limited amount of errors • Don’t beat a dead horse • Encourage self-critique • Constructively correct behaviors, attitudes & actions that hamper performance • Foster self-reflection, trust, open communication & confidentiality • Use Evidence-Based debriefing methodologies

33. DETRACTING FACTORS DURING IN-PATIENT SCENARIO: •  Lack of upfront explanation & purpose • Autocratic attitude • Not recognizing students’ emotions • Yes/no answers • Excessive instruction • Putting too much in simulation scenario

34. References Dismukes, R., Gaba, D., and Howard, S. (2006). So many roads: Facilitated debriefing in healthcare. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 1(1), 23-25. Dreifuerst, K. (2009). The essentials of debriefing in simulation learning: A concept analysis. Nursing Education Perspectives. Retrieved December 12, 2011 from, http://findarticles.com/p/articles/mi_hb3317/is_2_30/ai_n31637216/ Fanning, R. (2007). The role of debriefing in simulation-based learning. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2(1), 1-10. INACSL Board of Directors (2011). Standards of Best Practice: Simulation. Clinical Simulation in Nursing, 7 (S1). http://www.nursingsimulation.org/issues?issue_key=S1876- 1399%2811%29X0005-1 Jeffries, P. R. (2005). A framework for designing, implementing, and evaluating simulations used as teaching strategies in nursing. Nursing Education Perspectives, 26(2), 96-103.

35. References Jeffries, P. R., & Rizzolo, M. A. (2006). Designing and implementing models for the innovative use of simulation to teach nursing care of ill adults and children: A national, multi-site, multi-method study. Summary Report, New York, New York: National League for Nursing Retrieved from http://www.nln.org/research/LaerdalReport.pdf Jeffries, P. R. (2007). Simulation in nursing education: From conceptualization to evaluation. New York: National League for Nursing. Johns, C. (1995). Framing learning through reflection within Carper’s fundamental ways of knowing in nursing. Journal of Advanced Nursing, 22(2), 226-234. Larew, C., Lessans, S., Spunt, D., Foster, D., & and Covington, B. G. (2006). Innovations in clinical simulation application of Benner's theory in an interactive patient care simulation. Nursing Education Perspectives, 27(1), 16-21. Retrieved from http://web.ebscohost.com.authenticate.library.duq.edu/ehost/pdfviewer/pdfviewer?hid =108&sid=1fe0fb0a616e-4165-8e62-5b32aae087ad%40sessionmgr111&vid=2

36. References National League for Nursing Simulation Innovation Resource Center (NLN- SIRC). (2010). SIRC glossary. Retrieved January 19, 2012 from http://sirc.nln.org/mod/glossary/view.php?id=183 Rudolph, J., Simon, R. Dufresne, R., and Raemer, D. (2006). There’s no such thing as “nonjudgmental” debriefing: A theory and method for debriefing with good judgment. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 1(1), 49-55. Van Heukelom, J., Begaz, T., and Treat, R. (2010). Comparison of postsimulation debriefing versus in-simulation debriefing in medical simulation. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 5 (2), 91-97.