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Debriefing in Nursing Education: Theory, Methods, and Best Practices

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  1. Debriefing Maria Overstreet, PhD (c), RN, CCNS

  2. Seven Objectives for Today! • Importance of debriefing, historical perspective. • Educational theory supporting debriefing. • Components of debriefing nurse educators use. • Various methods of debriefing. • When to use which method. • How do you determine which method works best? • Learn while having fun.

  3. History • Term Debriefing • What does it mean to you? • Military • Psychology • Nursing

  4. History • WWII • Brigadier General Marshall • CISD (Critical Incident Stress Debriefing) • Mitchell • PD (Psychological Debriefing) • Dyregrov • Hall • Stress in nurses’ daily work life: stress debriefing

  5. Theory • Theory • educational literature supports need to debrief following an experiential learning exercise • Bloom’s Taxonomy? • Domains: Cognitive, Psychomotor, Affective

  6. Experiential Learning & Reflective Practice • Dewey (1938) • Interaction • Continuity • Kolb (1984) • Experiential learning process • Concrete Experience, Reflective Observation, Abstract Conceptualization, Active Experimentation • Schön (1987) • Reflective practice

  7. Kolb’s Experiential Learning Model Overlaid with Nursing Clinical Simulation Debriefing (by Overstreet 2008)

  8. Reflective Practice • Schön’s theory of reflective practice (1987) • Reflection in action • Reflection on action

  9. Rudolph, Simon, Dufresne, & Raemer (2006) • What is good judgment? • Judgment, bad judgment, good judgment • Experienced opinion delivered in a respectful manner • Advocacy & Inquiry • Conversational technique • Good judgment + genuine curiosity • Double loop learning • Argyris & Schön (1978) • Frames Actions Results

  10. Medical Literature • Gaba, et al. (2001): Anesthesia Crisis Resource Mgmt • Dismukes, et al. (2006): Role of facilitator • Bond, et al. (2004): Mistakes can cause reflection • Savoldelli, et al. (2006): Value of debriefing

  11. Nursing Literature • Definition • Essential components • Lasater • Baldwin • Jefferies • Johnson-Russell • NLN, Laerdal 3 year study • Jefferies • Most important design feature of simulations was debriefing • Decker • Philosophical underpinnings • Tables to offer simplicity to novice

  12. Methods to Use • Various ways to debrief: • Plus/Delta • Facilitator • Lecture • Psychological • Good Judgment • Link to real life experiences

  13. Which method? • Which method matches content of simulation exercise and goals? • What pieces of the simulation do you desire to bring forth: ethics, culture, value, moral, psychomotor skill, knowledge, or emotion? • How do you expect the student will respond? • Determine which method works best for you as the educator…most of all Be flexible!

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