Debriefing for Emotions vs Education: When and Why Julie Arafeh MSN, RN.

Debriefing for Emotions vs Education: When and Why

Julie Arafeh MSN, RN

Julie Arafeh has no disclosures to report

Objectives

•Compare the goals of debriefing for psychological support to that of debriefing for human and system performance

•Describe how a series of performance-based questions can be used to objectively guide debriefing

•Review how performance-based questions can be used in difficult debriefing situations

What is debriefing?

Debriefing Definitions

•Officially question someone about a job or experience

•Interrogate after an event to obtain useful information

•Carefully review upon completion

Merriam-Webster

Types of Debriefing

•Psychological debriefing beneficial for emotional release after a difficult experience

•Human and system performance debriefing goal is to objectively review events often comparing performance to national or hospital standards in order to improve or maintain performance ▫System issues that impede performance are

noted and addressed

Feedback vs Debriefing

•Feedback – review or critique, usually instructor dominant

•Debriefing – instructor facilitates discussion among learners

J Perinat Neonat Nurs 2010; Vol. 24( 4):, pp. 302–309

Role of Debriefing

•Occurs immediately after scenario•Confidential discussion•Private location•Capture system issues, near misses

Role of Debriefing

•Where the learning occurs•Experiential Learning (Kolb)

Experience in action (simulation) Observation and reflection (debriefing) Theorizing (debriefing) Experimentation and change (simulation)

What is a good debriefing?

In a good debriefing•Learning objectives are discussed in a constructive, concise manner

•Remains learner focused/driven•Well organized•Identifies gaps in knowledge, performance

•Engages all learners regardless of whether or not they were involved with actual simulation

Tips for Successful Debriefing

Start with Learning Objectives

•Cognitive•What you want learners to know

•Technical•What you want learners to be able

to do•Behavioral

▫Team skills – communication, role delegation, leadership

Start with Learning Objectives

•Relevant to learners•Maximum 3-5 learning objectives per scenario

•Keep scenarios short in duration in order to focus on learning objectives▫Facilitates thorough review of scenario

•Measureable

Learning Objectives

•Understand NRP algorithm▫Identify steps in NRP algorithm based on HR and time

•Utilize good communication skills▫Communicate with team using directed, closed loop communications

Learning Objectives•Bag mask ventilate a patient

▫Effectively ventilate patient as demonstrated by good seal, correct pressures and rate

•Assume the leadership role▫Demonstrate good leadership through continued reassessment of patient/situation, invitation of input from team, maintain big picture perspective

Develop A Debriefing Checklist

•List of critical behaviors in the scenario▫Completed during scenario by debriefer, other simulation faculty or learner not in scenario

•Based on learning objectives, policies and procedures, algorithm

Sample Checklist

Action Yes/No Comments

Establish unresponsiveness

Call for OB provider, Code team, Peds team

Lower head of bed, begin compressions

Debriefing Checklist: Metrics

•Add measurements▫Time▫Number of occurrences

•Metric standard or Goal ▫Give to learners prior to scenario▫Compare performance to goal/standard

Sample Checklist (cont)

Action Yes/No Comments

Lower head of bed, begin compressions

Time confirmed unresponsive to chest compressions

Unresp confirmed:Compressions started:

Time unresponsiveness to defibrillation

Defibrillation:

Time of call to code team to arrival

Code team called:Arrival:

Debriefing Questions

•Open-ended questions based on learning objectives

•Designed to facilitate discussion•Used during debriefing as an aid•Organized by appearance in scenario

Learning Objectives for Maternal Arrest•Cognitive

▫List common “H’s and T’s” of pregnancy

•Technical ▫Perform chest compression mid-sternum at rate of 100/min with depth of 2 inches

•Behavioral ▫First responder will assign roles to other responders as they arrive on scene

Debriefing Question Organization•Technical

▫How are the compressions that are being delivered at this time?

•Behavioral▫What roles are the first responders in?

▫How did the role assignment hinder/facilitate following the algorithm?

Debriefing Question Organization•Cognitive

▫What are the most common H’s and T’s in pregnancy?

▫What is the differential diagnosis in this case?

Questions When You are Stuck...

•What just happened?•What circumstances led to that?

•What can be done to ▫facilitate that positive event?▫prevent that negative event?

Use the Video

•Be sure video captures learning objectives during scenario

•Stop video for▫Learning objectives▫Unexpected actions/occurrence

•Particularly good for discussion of behavioral objectives

Large Range of Learner Experience•Questions for new staff

▫What are the signs that an OB patient is decompensating?

▫What would trigger a call for help?

Large Range of Learner Experience•Questions for more experienced staff

▫What is the best way to organize the room for this situation?

▫ Who do you need in the room? What do you want them to do?

▫What equipment do you need? ▫What do you need to prepare if the

situation worsens?

Problem with Scenario or Equipment

•Acknowledge there was a problem and move to a question

•If it is realistic▫Could this happen?▫Has this happened to anyone?

Perfect Performance in Scenario•Stop video when tasks completed

efficiently and effectively▫What has been accomplished so far▫How does this compare to the

algorithm/policy?▫What helped the team?▫What was good about the communication/

leadership/ role delegation?

No/Few Learning Objectives Met•Stop video BEFORE a key procedure or assessment or at beginning of algorithm▫Have learners discuss what should happen based on patient status

No Learning Objectives Met

•Watch video, stopping frequently to determine what happened to deter team ▫OFTEN behavioral issues like role delegation, lack of a leader, communication issues or system issues are evident

References• Sawyer TL, et al. Adaption of the US Army's

After-Action Review for Simulation Debriefing in Healthcare. Sim Healthc 2013;8:388-397.

• Edelson DP, et al. Improving in-hospital cardiac arrest process and outcomes with performance debriefing. Arch intern med. May 26, 2008;168(10):1063-1069.

• McGreevy JM, et al. Briefing and debriefing in the operating room using fighter pilot crew resource management. J Am Coll Surg. Jul 2007;205(1):169-176.

References• Dismukes RK, et al. So many roads: facilitated

debriefing in healthcare. Simul Healthc. Spring 2006;1(1):23-25.

• Bartone PT, et al. Event-oriented Debriefing Following Military Operations: What Every Leader Should Know. In: 29218 USAMRU, ed. Maryland: USAMRU-E;1995.

• McDonnell LJK, et al. Facilitating LOS Debriefings: A training manual (NASA Technical Memorandum 112192. In: Administration NAaS, ed. Moffett Field, CA 1997. Division MOBFCS. Apollo 13 Technical Crew Debriefing. In: Administration NAaS, ed. Houston Texas 1970:198.

jarafeh@stanford.edu