Debriefing is an integral part of every quality simulation. The best debriefing experience allows
the students to discuss, digest, and discover. The facilitator's role in debriefing is to guide the
discussion and to keep the conversation on topic. However, the facilitator's comments about the
simulation should be kept to a minimum. The student participants should provide the majority of
the discussion.
Phase 1: Student Reaction
Simulation experiences can be very emotional. The reaction phase allows the students to vent
their feelings so that further discussion and learning can occur.
Examples of appropriate facilitator comments include:
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"Tell us about what you experienced during the simulation."
"Please share some initial thoughts about the case."
Phase 2: Student Reflection
During the reflection phase, the facilitator asks the students to reflect on their decision-making
process and on the actions taken during the simulation. Observers can comment using the
Observer Evaluation Rubric.
Examples of appropriate facilitator comments include:
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"Describe your thought process as you made decisions about _______."
"What patient response (or assessment) led you to _______?"
"Did the patient respond the way you thought he/she would?"
Phase 3: Responsive Inquiry
Facilitators can use the Performance Checklist to identify and guide areas for inquiry.
Examples of appropriate facilitator comments include:
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"I noticed _______. What did you think about that?"
"I am wondering why _______. Would you describe more about this?"
Phase 4: Integration
During the integration phase, the facilitator assists the students to apply theoretical content to the
simulation as well as to anticipate the transfer of knowledge to the clinical setting.
Linking Theory to Practice:
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Use the debriefing questions designed for the specific scenario.
Assimilation:
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"How will this experience influence your patient care?"
"What will you now do differently to prepare for clinical?"
Phase 5: Closure
With 1-2 minutes left, ask for any final thoughts on the scenario or the simulation experience.
End with positive comments, such as:
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"I really appreciate how you _______."
"It seems like this was a really good learning experience."
"I really appreciate everyone's participation."
1. Maurice Arviso states, "I am short of breath." What assessment findings should the nurse
obtain based on his statement?
Possible Answers
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Lung sounds in all lobes
Pulse oximetry
Posture of patient
Quality of breathing/respiratory rate
Temperature
Pulse rate
Level of consciousness
Capillary refill
Color
Presence of secretions
Subjective data
Rationale
p. 917: There are many components included in the physical assessment of a patient with a
diagnosis of pneumonia. The focus is on perfusion.
Remediation Reading Assignment
"Thorax and Lungs," pp. 592-598
"Hypoxia," p. 917
"Physical Examination," pp. 921-922
Multimedia Resources
Assessing Apical Pulse
Assessing Radial Pulse
Understanding the Purpose of the Pulse Oximeter
Using a Pulse Oximeter
2. What questions would be appropriate for a nurse to ask when gathering subjective data
from a patient with a history of a cough?
Possible Answers
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How long have you had the cough?
Does anything make the cough better? Worse?
Have you been sick recently?
Do you work in an environment that contains pollutants such as dust, smoke, etc.?
Do you have any allergies to pollens, dust, etc.?
Do you have any medication allergies?
Have you had a flu shot this season?
Have you ever smoked? If so, how many packs and for how long?
Does anyone in your household smoke?
Has anyone in your family had tuberculosis?
Rationale
p. 920: It is important to know the environmental conditions of a patient with a history of a
cough. It is important to assess the family history, health promotion (such as immunizations),
smoking history, and allergies that may indicate a higher risk for serious complications related to
the cough.
Remediation Reading Assignment
"Nursing History for Lung Assessment," p. 594
"Assessment," pp. 918-921
3. What assessment data should the nurse collect regarding the patient's sputum?
Possible Answers
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Color
Odor
Quantity
Consistency
Presence of blood
Change in color of sputum
Rationale
p. 921: It is important to assess the sputum to determine if there is an additional underlying cause
for the cough.
Remediation Reading Assignment
"Sputum Characteristics," p. 921
4. Prior to the start of the scenario, a nurse took a telephone order and documented
"telephone order read back" in Maurice Arviso's EMR. What is the proper procedure for
taking a telephone order and how does this procedure promote patient safety?
Possible Answers
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Clearly determine the patient's name, room number, and diagnosis
Repeat any prescribed orders back to the provider
Use clarification questions to avoid misunderstandings
Write TO (telephone order) or VO (verbal order)
The provider must co-sign the order within the timeframe required by the institution
Rationale
p. 402: Communication and receiving of orders have been identified by national organizations as
a concern for patient safety. It is imperative that the nurse receiving the order clarifies the order
and ensures that all communication is clear.
Remediation Reading Assignment
"Telephone or Verbal Orders," pp. 402-403
5. Describe the objective manifestations of dyspnea.
Possible Answers
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Exaggerated respiratory effort
Use of the accessory muscles of respiration
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Nasal flaring
Marked increases in the rate and depth of respirations
Rationale
p. 920: Dyspnea is the subjective sensation of feeling short of breath or experiencing difficult or
uncomfortable breathing. Dyspnea usually occurs upon exertion or exercise, but can also occur
as a result of various pulmonary diseases, cardiovascular diseases, neuromuscular conditions,
and anemia. Pregnant women in the final month of pregnancy may experience dyspnea.
Environmental factors such as pollution, cold air, and smoking can exacerbate dyspnea.
Remediation Reading Assignment
"Dyspnea," p. 920
1. Discuss some of the signs and symptoms exhibited by a patient experiencing a problem with
oxygenation.
Correct answer(s): When a patient experiences problems with oxygenation, virtually every
body system is affected as cells become oxygen deprived. Alterations in mental alertness, such as
sleepiness, are common since the brain is very sensitive to oxygen deprivation. Other signs and
symptoms include nasal flaring, shortness of breath, and cyanosis. A thorough assessment of all
body systems may reveal signs and symptoms of oxygen deprivation
2. Discuss the landmarks of the chest that will assist with performing an accurate lung
assessment
Correct answer(s): Identification of the landmarks of the chest aids in pinpointing the location
of findings obtained from the assessment. The nurse should keep a mental picture of these
landmarks connected with imaginary lines in order to ensure a thorough assessment of the
anterior, lateral, and posterior areas of the thoracic cavity. The landmarks include the nipples,
angle of Louis, suprasternal notch, costal angle, clavicles, and the vertebrae.
3.Discuss the safety precautions that are associated with oxygen therapy.
Correct answer(s): Since oxygen is a combustible gas, smoking or a spark from electrical
equipment can cause a fire when oxygen is present; therefore, no smoking signs should be visible
when oxygen is in use and all electrical equipment should be grounded. Additional safety
precautions include keeping portable tanks upright, ensuring that portable tanks are full when
transferring a patient’s oxygen supply to a portable tank, and following the health care provider’s
order for oxygen.