Debriefing Methods for Simulation in Healthcare: A Systematic Review

ABSTRACT

Debriefing is a critical component in most simulation experiences. With the growing number of debriefing concepts, approaches, and tools, we need to understand how to debrief most effectively because there is little empiric evidence to guide us in their use. This systematic review explores the current literature on debriefing in healthcare simulation education to understand the evidence behind practice and clarify gaps in the literature. The PICO question for this review was defined as "In healthcare providers [P], does the use of one debriefing or feedback intervention [I], compared to a different debriefing or feedback intervention [C], improve educational and clinical outcomes [O] in simulation-based education?" We included 70 studies in our final review and found that our current debriefing strategies, frameworks, and techniques are not based on robust empirical evidence. Based on this, we highlight future research needs.

Identification of the barriers and enablers for receiving a speaking up message: a content analysis approach

BACKGROUND

Within healthcare, the barriers and enablers that influence clinicians' ability to speak up are well researched. However, despite the receiver of the message being identified as a key barrier to a speaker voicing a concern, there have been very few receiver-focused studies. As a result, little is known about the barriers and enablers that influence message reception. Understanding these can help inform speaking up training and ultimately enhance patient safety through more effective clinical communication.

OBJECTIVES

To identify enabling or inhibiting factors that influence the receiver's reception and response to a speaking up message, and if the identified barriers and enablers are related to speaker or receiver characteristics.

DESIGN AND METHODS

Twenty-two interdisciplinary simulations were video recorded and transcribed. Simulation participants formed the patient discharge team and were receivers of a speaking up message, delivered by a nurse at the patient's bedside. How the message was delivered (verbose or abrupt wording), was manipulated and counterbalanced across the simulations. Within the post simulation debriefs, barriers and enablers of being a receiver of a message were explored using content analysis.

SETTING/PARTICIPANTS

This study took place in a large Australian tertiary healthcare setting. Participants were qualified clinicians of varying disciplines and specialties.

RESULTS

A total of 261 barriers and 285 enablers were coded. Results showed that how the message was delivered (differing tone, phases, and manner) influenced what receivers identified as barriers and enablers. Additionally, the receiver's own cognitive processes, such as making positive attributions of the speaker and attempting to build rapport and collegiality, better enabled message reception and response. Receiver behaviour was negatively impacted by listening to fix, rather than understand, and not knowing in the moment how to manage their own reactions and appropriately frame a response.

CONCLUSION

The debriefings identified key barriers and enablers to receiving a speaking up message that differ from those previously identified for senders of the speaking up message. Current speaking up programs are predominately speaker centric. This study identified that both speaker and receiver behaviour influenced message reception. Therefore, training must place equal attention on both the speaker and receiver and be inclusive of experiential conversational rehearsal of both positive and challenging encounters.

Transforming Team Culture: A Case Study From Critical Care

Interprofessional team conflict amplifies division and impedes patient care. Normal differences of opinion escalate to frank conflicts when members respond with indignation or resentment. These behaviors engender a workplace culture that degrades collaborative clinical management and patient safety. We describe the impacts of dysfunctional team culture along with interventions that can lead to more productive teams. In our case study, an interprofessional group of critical care clinicians recognized that their interactions impaired collaborative care and requested support. Two experts, a nurse and a physician, facilitated two 2-h workshops with 18 critical care physicians, nurses, and fellows to begin transforming their dysfunctional unit culture. After establishing psychological safety, facilitators introduced the learning pathways grid to explore (1) how faulty assumptions lead to dysfunctional interactions and suboptimal results and (2) how new assumptions informed by new insights enable teams to redesign their interactions. Through reflection and analysis, clinicians concluded that understanding other clinicians' goals and perspectives benefits patients and families, helps clinicians feel valued, and fosters mutual trust. This exercise supports interprofessional teams to transform dysfunctional interactions by helping team members to develop a mindset of humility and inquiry and to remind themselves about the good intentions in others. To address conflict, we offer a conversational approach grounded in curiosity, respect, and transparency. Ultimately, the most important communication strategy for effective critical care is caring about the perspectives and experiences of other members of the interprofessional team.

The influence of professional identity on how the receiver receives and responds to a speaking up message: a cross-sectional study

BACKGROUND

Research focused on understanding what enables or hinders health professionals to speak up about a safety concern has been to date predominately atheoretical and speaker focused. However, the role the receiver of the message plays in these often-difficult encounters is highly influential. To date, speaking up programs have created conversational mnemonics that technically should respectfully engage the receiver, yet speaking up remains challenging. This paper utilises Communication Accommodation Theory to explore the impact the communication behaviour and speaker characteristics has on the receiver of a speaking up message, and if these impacts differ between receiver groups (clinical disciplines).

METHOD

Clinicians (N = 208) from varying disciplines responded to two hypothetical speaking up vignettes, where participants were the receivers of speaking up messages. Analysis of variance was used to explore any potential differences between receiver groups.

RESULTS

Findings indicated that the level of perceived accommodation and group membership, whether defined by speaker discipline or seniority, collectively influenced how the receiver of a speaking up message evaluated the interaction, which influenced their anticipated response to the speaker.

CONCLUSIONS

The receiver's perceptions and evaluations of the message, their own professional identity and the presence of others, influenced receivers' anticipated responses. This has direct implications on healthcare speaking up training and provision of care, as the varying clinical disciplines received and responded to the same messages differently.

Teaching, coaching, or debriefing With Good Judgment: a roadmap for implementing “With Good Judgment” across the SimZones

Simulation-based learning occurs in multiple contexts, and one teaching style cannot adequately cover the needs at each learning level. For example, reflective debriefing, often used following a complex simulation case, is not what is needed when learning new skills. When to use which facilitation style is a question that educators often overlook or struggle to determine. SimZones is a framework used to clarify the multiple contexts in simulation. This framework, combined with elements of Debriefing With Good Judgment, can help educators match the appropriate facilitation style with learner needs and learning context. We have distilled the core elements of the “with good judgment” approach to debriefing and applied them to the SimZones framework to guide educators with (1) what type of learning can be expected with each learning context, (2) what behaviors and activities can be expected of the learners in each learning context, (3) what instructional strategies are most effectively used at each stage, and (4) what are the implications for the teacher-learner relationship.

Engaging Learners in Productive Struggle: Escape Rooms as a Teaching Tool

BACKGROUND

Designing and engaging learners in active learning are critical skills for nursing faculty with the resulting educational pay-off of increased engagement and learning. Moving away from the standard PowerPoint presentations can be uncomfortable for faculty and result in not taking risks when designing new learning experiences. However, creating psychological safety for both the faculty and learners can result in deeper learning and growth for the faculty's skill set.

METHOD

This article describes a pilot implementation of an escape room to facilitate an exam review for an undergraduate pathophysiology course.

RESULTS

This pilot allowed the program to determine the feasibility of integrating escape rooms into undergraduate nursing curriculum while including evidence-based pillars of active and experiential learning such as the creation and maintenance of psychological safety for students and faculty.

CONCLUSION

Lessons learned about in-person and virtual escape rooms are included as well as next steps. [J Nurs Educ. 2022;61(X):XXX-XXX.].

Evidence-Based Debriefing

Ongoing shifts in the healthcare system require practitioners who possess metacognitive skills to evaluate their decisions and the thinking and rationale guiding those decisions. In an effort to design learning activities that support metacognition in nursing education, undergraduate and graduate faculty, are embracing simulation-based education (SBE) as an effective teaching and learning strategy. SBE includes prebriefing, the simulation scenario, and debriefing, all of which are supported by psychological safety. Prebriefing precedes the entire learning process and is integral to engagement in the simulation and to the effectiveness of the debriefing. Debriefing provides educators with the opportunity to explore and develop those metacognitive skills with learners. In this chapter on evidence-based debriefing, the authors will explore the evidence and theories surrounding best practices in SBE, specifically the prebriefing and debriefing components of the learning experience. The chapter explores the theoretical foundation of SBE and theory-based debriefing; educational best practices of prebriefing as an integral part of an effective debriefing; theory-based debriefing models; research evidence of debriefing outcomes; evaluation of the prebriefing and debriefing process; and finally, provides recommendations on the priorities for further research in debriefing. Within this chapter, the term educator is inclusive of undergraduate, graduate, and professional development nurse educators and reflects the educator role in SBE.

A New Role for the ACNP

The implementation of a rapid response team or medical emergency team is 1 of the 6 initiatives of the Institute for Healthcare Improvement's 100,000 Lives Campaign with the goal to reduce the number of cardiopulmonary arrests outside the intensive care unit and inpatient mortality rates. The concept of RRT was pioneered in Australia and is now being implemented in many hospitals across the United States. This article reviews the current literature and describes the implementation of an RRT in a community hospital. The first-quarter data after implementation are described. The unique role of the acute care nurse practitioner in this hospital's model is described.