The art and science of debriefing
Download
1 / 50

The Art and Science of Debriefing - PowerPoint PPT Presentation


  • 301 Views
  • Uploaded on

The Art and Science of Debriefing. Maria Overstreet, PhD, RN, CCNS. Who Am I?. Nashville Native History: Nurse for 25 years Simulation: just happened into it… Debriefing: Chose to perform research Simulation Consultant: Enjoy doing!. Objectives. Learner will become more knowledgeable of:

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'The Art and Science of Debriefing' - Rita


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
The art and science of debriefing l.jpg

The Art and Science of Debriefing

Maria Overstreet, PhD, RN, CCNS


Who am i l.jpg
Who Am I?

  • Nashville Native

  • History: Nurse for 25 years

  • Simulation: just happened into it…

  • Debriefing: Chose to perform research

  • Simulation Consultant: Enjoy doing!


Objectives l.jpg
Objectives

  • Learner will become more knowledgeable of:

    • Debriefing in respect to:

      • History

      • Meaning

      • Concepts

      • Methods

      • Application


Debriefing l.jpg
Debriefing

  • Has anyone ever facilitated a simulation debriefing?

  • How do you define Debriefing?



Literature of debriefing military l.jpg
Literature of Debriefing: Military

  • WWII, Army’s chief historian, Brigadier General Marshall

    • Performed 1st Historical Group Debriefing (HGD)

      • Soldiers recounted events of combat, feelings, & decisions

      • Unexpected finding was psychological benefits

        • Termed Spiritual Purging symbolizing cleansing of one’s actions during combat

  • Fillion, Clements, Averill, & Virgil (2002), MacDonald (2003)


Literature of debriefing psychology l.jpg
Literature of Debriefing: Psychology

  • Mitchell (1983) a psychologist

    • Worked with emergency services personnel

    • Developed method of debriefing

      • Critical incident stress debriefing (CISD)

        • Recount events, discuss actions/decisions, discuss feelings

    • Dyregrov (1989) adapted Mitchell’s technique

      • Emphasized process and flexibility

        • Particularly time and routine


Psychology l.jpg
Psychology

  • Red Cross Debriefing of 1989 San Francisco earthquake

  • Found small group size allowed for more intimate exploration of worker’s thoughts & feelings (12-15 for 2 hours).

  • Concurs with Dyregrov 2 factors important:

    • Time & timing

      • Length of time of debriefing

      • Proximity to the event


Literature of debriefing education l.jpg
Literature of Debriefing: Education

  • No works from education literature are evidence based research studies.

  • Provide important theoretical and conceptual information

    • Lederman (1984) differentiates educational debriefing from other debriefings due to emphasis on the learning derived from the experience.

      • Proposed term “postexperience analytic discussion process” (Lederman, 1984, p. 415)

      • Refined term to “cognitive assimilation of experience”





Concepts of literature important in debriefing l.jpg
Concepts of Literature Important in Debriefing

  • Communication

    • Discussion of events: What happened?

    • Language use: words & body

  • Time/Timing

    • Time is a controversial factor

      • How long, who speaks for how long, & role of silence

      • Timing: when to introduce or stimulate a discussion

  • Emotion

    • Attention to the affective domain: feelings & emotions

  • Structure

    • Pattern of organization, how it flows; anticipation of learner of what is to come


Research of healthcare debriefing l.jpg
Research of Healthcare Debriefing

  • Points to VALUE of debriefing

  • Savoldelli, et al (2006)

    • Verbal & verbal + video improved skill performance

  • Jefferies & Rizzolo (2006)

    • Learner identified debriefing as the most important design feature of simulations

    • Learner’s self-confidence ratings increased with active learning followed by reflective exercises


Research of healthcare debriefing15 l.jpg
Research of Healthcare Debriefing

  • Lasater (2007)

  • Studied simulation & critical thinking

    • Comments on necessity of assisting students to cope with their emotions following simulation

      • Addresses the affective domain of learning


Research of healthcare debriefing16 l.jpg
Research of Healthcare Debriefing

  • Johnson-Russell (2007)

  • Presents a loose structure for debriefing

  • Refers to 4 stages:

    • Introduction

    • Personal reaction [psychological component]

    • Discussion of events [What happened?]

    • Summary [Synthesis of knowledge, meaning making]


Theory of experiential learning l.jpg
Theory of Experiential Learning

  • Dewey (1938)

  • Learning by doing

  • Not every experience results in education or learning

  • LEARNER must:

    • Interact with environment

    • Make meaning of the experience from past, present, or future


Theory of experiential learning18 l.jpg
Theory of Experiential Learning

  • Debriefing by Dewey’s theory of experiential learning…

  • Reflective component

    • Provides opportunity to link knowledge and experience or knowledge, skill, and meaning derived by the learner


Theory of experiential learning19 l.jpg
Theory of Experiential Learning

  • Kolb (1984)

  • Experiential learning model

  • Represents 4 cyclic stages learners venture through to understand experiences

  • Reflective Observation

    • Discuss experience, ponders what went well & not, seeks affirmation or learns alternative method, gains insight



Theory of experiential learning21 l.jpg
Theory of Experiential Learning

  • Schön (1987)

  • Learning through reflecting as it relates to practice professions

  • Isolated reflection & expanded on its meaning

    • 2 methods of reflection in practice:

      • Reflection in action (thinking while performing)

      • Reflection on action (pose ? To self to change)


Research of nursing clinical simulation debriefing l.jpg
Research of Nursing Clinical Simulation Debriefing

  • Overstreet (2009)

  • Qualitative study

  • Case study design (4 independent cases)

  • Data

    • Observation & field notes

    • Video of debriefings

    • Facilitator interview

    • Facilitator questionnaire

    • Student questionnaire


Overstreet s research findings l.jpg
Overstreet’s Research Findings

  • Original 4 concepts from literature emerged

    • Communication

    • Time/Timing

    • Structure

    • Emotion


Additional patterns emerged l.jpg
Additional Patterns Emerged

  • Triangulation of data sources: from both students and facilitators

    • Accentuate the positive

    • Higher Order Thinking

    • Experience Counts


Methodology design l.jpg
Methodology & Design

  • Qualitative Research

    • Explore phenomenon through identifying idiosyncratic patterns of behaviors

    • When little is known

      • Madjar & Walton, 2001

  • Case Study

    • Investigate a contemporary phenomenon within its real-life context

    • Multiple sources of data

      • Yin, 2003


  • Focal points l.jpg
    Focal Points

    • Teacher

      • Student

        • interaction

  • Process

    • time spent in certain aspects of exchange

  • Content

    • what is communicated


  • Actual research l.jpg
    Actual Research

    • IRB Approval

    • Protocol remained same for each data collection

      • Observe

      • Videotape

      • Student Questionnaire

      • Educator Semi-structured Interview

      • Educator Questionnaire

      • Field Notes


    Case study analysis of data l.jpg
    Case Study Analysis of Data

    • Triangulation of multiple data sources

    • Categorical aggregation

    • Time-ordered analysis

    • Pattern matching

    • Cross-case synthesis


    Case 1 using storytelling l.jpg
    Case 1: Using Storytelling

    • Pre-simulation – 30

    • Simulation – 30

    • Debriefing – 25

    • Content – Med/surg

    • Students – 6 (22 yr old)

      • AD, (1 AA, 5 Cau, 1♂)

    • Educator – Cau, ♀

      • 23 yr RN, used personal storytelling for emphasis

      • Tone - Natural


    Case 2 the therapeutic milieu l.jpg
    Case 2: The Therapeutic Milieu

    • Pre-simulation – 5

    • Simulation – 105

    • Debriefing – 47

    • Content – Skill practice

      • Communication w/pt.

    • Students – 7 (22 yr old)

      • BSN, (1AA, 6 Cau, all ♀)

    • Educator – 2, Cau, ♀

      • 14 & 4 yrs RN

      • Structured, safe & trusting atmosphere


    Case 3 the critical critical care nurse l.jpg
    Case 3: The Critical, Critical Care Nurse

    • Pre-simulation – 5

    • Simulation – 50

    • Debriefing – 28

    • Content – Cardiac/ED

      • Decisions at point of care

    • Students – 3 (38 yr old)

      • BSN, (All Cau, 1 ♂, previous roles)

    • Educator – 2, Cau, ♀

      • 18/10 yr RN

      • Feedback(-),(93 ?/20min)


    Case 4 preparing for the future l.jpg
    Case 4: Preparing for The Future

    • Pre-simulation – 5

    • Simulation – 90

    • Debriefing – 38

    • Content-Sepsis/ED/ICU

      • Decisions at point of care

    • Student – 7 (22 yr old)

      • BSN, 1 AA, 1 ♂

    • Educator - ♀ Cau.

      • 38 yr RN/34 yr teaching

      • Interweave of emotion




    Patterns l.jpg
    Patterns

    • Structure

      • All 4 heavy in structure, physical environment

        • Case 1: driven by written questions

        • Case 2: (+) peer feedback

        • Case 3: knowledge questions

        • Case 4: less defined: variety of teaching methods

    • Communication

      • Listening: to hear with thoughtful attention

      • Language: words, pronunciation, includes tone and body

      • Pattern frequencies: links, swoops, timing

      • Case 4 – swoop 8 times / Case 2 – no swoops in analysis


    Patterns36 l.jpg
    Patterns

    • Time

      • Time spent in debriefing – 25-47 min.

      • Educator talk time 18 – 30 min.

      • Silence 0 – 5 min.

      • Case 2: Outlier student talk time

      • Case 3: Students answered 57 X in 2.5 min(2.6 sec/answer)

    • Emotion

      • Case 1 & 4: Storytelling and interweave of emotion

      • Case 3: Negative vs positive feedback (18/9/5)

        • “I was thinking their knowledge base was a little more than what it may have been”


    New patterns emerged l.jpg
    New Patterns Emerged

    • Accentuate the Positive

    • Higher Order Thinking

    • Experience Counts


    Accentuate the positive l.jpg
    Accentuate the Positive

    • Educators unanimously perceived students & themselves (+)

      • “I try to end it in a positive by asking the students a couple of things they learned today that they didn’t know before…”

      • “Cause we want them to leave feeling positive about simulation and not being terrified and being embarrassed cause we are using simulation in every single course”

    • Students: What did today’s debriefing mean?

      • “It was feedback I needed to hear. It helps me identify + and -.”

      • “to discuss people’s strengths and areas that need to be worked on in a positive manner”


    Higher order thinking l.jpg
    Higher Order Thinking

    • Putting It All Together

      • Meaning making: Students

        • “Debriefing just put all the pieces of the puzzle together”

        • “Debriefing helped to pull everything together & make sense of it all”

      • Meaning making: Educators

        • Case 1: predetermined goal to connect theory & practice

        • Case 2: tie together student improvement

        • Case 3: tried to tie together knowledge from simulation

        • Case 4: cannot refrain from teachable moment


    Higher order thinking40 l.jpg
    Higher Order Thinking

    • Decision Making and Critical Thinking

    • Case 1 & 3: Dialogue about how decisions were made

    • Case 3: “You get to find out more about what they were thinking…”

    • Case 2: Skill focused: therapeutic communication process

    • Case 4: minimal skill focus, knowledge questions to ponder, overlaid with attention to attitude

    • Students: “Helps you learn & think critically” “to focus on your patient & not the monitors. Also it is important to think critically & prioritize your care”


    Experience counts l.jpg
    Experience Counts

    • Educators brought themselves to debriefing

    • More experienced vs. less experienced

    • Students value experience

      • “We practiced on a plastic dummy which just increased our chances of responding appropriately to the situation in real life”



    So what l.jpg
    So What?

    • Theory

      • Dewey, Kolb, Schön

    • Literature

      • Military, Psychology, Education

    • Concepts

      • Communication, Time/Timing, Structure, Emotion

    • Research Patterns

      • Accentuate +, higher order thinking, experience counts


    Gathered more knowledge l.jpg
    Gathered More Knowledge

    • Information to consider as you develop your own style of debriefing

    • Ask yourself the question

      • How will I address these concepts in debriefing?


    Consider objectives l.jpg
    Consider Objectives

    • Objectives for simulation add depth to debriefing

    • Are you going to allow the objectives for the simulation to guide the debriefing, structure the debriefing, limit the debriefing…


    How do objectives for simulation guide debriefing l.jpg
    How do objectives for simulation guide debriefing?

    • View code simulation

    • What is the objective for the simulation?

      • 1.) to feel the urgency of being involved in a code situation?

      • 2.) to administer accurate CPR?


    How much time l.jpg
    How much time?

    • Will you be very rigid with time

    • Will you be lax with time

    • Literature points to time as important:

      • How long? … As long as the experiential learning

      • For true reflection – have to spend silent time thinking


    How do i communicate l.jpg
    How do I communicate?

    • Video tape yourself…you will learn a lot!

    • Language is a powerful tool.

    • Example: [ + / Δ ]

    • How do you communicate this to the learner?

    • What was good/bad?

    • What was done well/what can be improved?

    • How do you list these items?

      • Include the learner in coming up with the items


    Communicate your findings l.jpg
    Communicate Your Findings

    • Theory

      • Your theory

    • Literature

      • What literature you produce

    • Concepts

      • Concepts you discover in your practice or observe in other’s practice

    • Research Patterns

      • Patterns you produce or you observe


    ad