Debriefing for Emotions vs Education: When and Why Julie Arafeh MSN, RN.
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Transcript of Debriefing for Emotions vs Education: When and Why Julie Arafeh MSN, RN.
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Debriefing for Emotions vs Education: When and Why
Julie Arafeh MSN, RN
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Julie Arafeh has no disclosures to report
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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
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What is debriefing?
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Debriefing Definitions
•Officially question someone about a job or experience
•Interrogate after an event to obtain useful information
•Carefully review upon completion
Merriam-Webster
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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
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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
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Role of Debriefing
•Occurs immediately after scenario•Confidential discussion•Private location•Capture system issues, near misses
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Role of Debriefing
•Where the learning occurs•Experiential Learning (Kolb)
Experience in action (simulation) Observation and reflection (debriefing) Theorizing (debriefing) Experimentation and change (simulation)
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What is a good debriefing?
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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
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Tips for Successful Debriefing
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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
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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
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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
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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
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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
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Sample Checklist
Action Yes/No Comments
Establish unresponsiveness
Call for OB provider, Code team, Peds team
Lower head of bed, begin compressions
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Debriefing Checklist: Metrics
•Add measurements▫Time▫Number of occurrences
•Metric standard or Goal ▫Give to learners prior to scenario▫Compare performance to goal/standard
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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:
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Debriefing Questions
•Open-ended questions based on learning objectives
•Designed to facilitate discussion•Used during debriefing as an aid•Organized by appearance in scenario
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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
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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?
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Debriefing Question Organization•Cognitive
▫What are the most common H’s and T’s in pregnancy?
▫What is the differential diagnosis in this case?
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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?
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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
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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?
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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?
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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?
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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?
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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
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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
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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.
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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.