SIMULATION DEBRIEFING ISN’T
ALWAYS AT THE END!
Ruth E. Irwin, MSN, RN
Pauline Freedberg, MSN, RN
Carie Shedlock, MSN, RN
Kathleen A. Malloy, PhD, RN
The presenters have no affiliation or
financial interest in any of the content or
equipment referred to in this presentation.
WCCC. 2012



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.





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
(Jeffries & Rizzolo, 2006)
 Simulations
are student
 Experiential
Learning
centered
Experience
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)
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).

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
ROLE OF EVALUATOR


Testing purposes
Observer
ROLE OF FACILITATOR


Provide Support
Cues




ask questions
what if?
Teaching Simulation
Guide Debriefing @
end or during
phases of the
simulation


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.


Prep Questions to lead and focus on objectives
of the simulation
Guided by Carper’s Fundamental Patterns of
Knowing in Nursing:
Empirical
 Aesthetic
 Personal
 Ethical
(Jeffries, 2007; Johns, 1995)

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?
Apply Theory to Clinical
Practice
Shock State
• Assessment
• Treatment
strategies
• Evaluation
Hemodynamic
Monitoring
• Oxygen
administration
• Basic
parameters
(arterial line,
CVP)
Intravenous
Medications
• Vasoactive
drug
titration
• Protocols
• Fluid
challenges
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.”
One Bite At
A Time
▀
▀
▀
▀
“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.”
http://www.teachingexpertise.com/e-bulletins/effective-debriefing-makingthinking-and-learning-skills-visible-7895






Prebriefing
“Redoing a skill”
Facilitator demonstration
“Rescue”
Teachable moments
“Expect the unexpected”
DVD clip from the beginning of Shock Sim
Scenario 1/12; Shows PreSim Setup – about 4
minutes.






Prebriefing
“Redoing a skill”
Facilitator demonstration
“Rescue”
Teachable moments
“Expect the unexpected”






Prebriefing
“Redoing a skill”
Facilitator demonstration
“Rescue”
Teachable moments
“Expect the unexpected”









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)






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
Clinical
Judgment
Clinical
Reasoning/
Critical
Thinking
Problem
Solving
Psychomotor
Skills







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






Lack of upfront explanation & purpose
Autocratic attitude
Not recognizing students’ emotions
Yes/no answers
Excessive instruction
Putting too much in simulation scenario
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.
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
National League for Nursing Simulation Innovation Resource Center (NLNSIRC). (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.