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.

Debriefing Practices in Nursing Education Programs: Results from a National Study.

AIM: The purpose of the study was to describe debriefing practices in nursing education programs in the United States. BACKGROUND: Despite the acknowledged importance of debriefing, little is known about debriefing practices. It is imperative that debriefing practices be examined in order to establish a baseline understanding of current practice. METHOD: The study design was a cross-sectional Internet-based survey. Surveys were sent to every accredited pre-licensure nursing program in the United States. Regression analysis determined variables that were associated with the use of theory-based debriefing. RESULTS: Data analysis determined that most debriefers do not have training in debriefing and that their competence was not assessed. Factors associated with the use of theory-based debriefing included the presence of a designated simulation administrator, training for debriefers, and competence assessment of debriefers. CONCLUSION: These results establish a baseline from which to prioritize faculty development in simulation-based education.

The Essentials of Debriefing and Reflective Practice.

Debriefing is a specific type of reflective learning. Debriefing follows an experience, with the goal of taking meaningful learning away from the experience. It is often used following a simulation-based educational experience but the same techniques can be used following actual clinical care. Early studies in simulation suggest that learning does not occur in simulation-based education in the absence of debriefing. There are phases of a debriefing discussion and specific conversational strategies that are used to engage learners and provoke engaging learning discussions. Standards of practice call for facilitators with specialized training and a debriefing method that is theory based.

Simulation for Competency Development in Clinical Practice.

Nursing education at the undergraduate and graduate levels is undergoing a transformational curricular change that includes moving toward a competency-based curriculum. This opportunity holds promise to close the education-practice gap that has plagued nursing education for decades. A key teaching modality to achieve this outcome is simulation-based education. This article will explore the interaction between simulation and competency-based education.

Testing reliability and validity of the Korean version of Debriefing Assessment for Simulation in Healthcare (K-DASH).

BACKGROUND: Use of the Debriefing Assessment for Simulation in Healthcare (DASH©) would be beneficial for novice debriefers with less or no formal training in debriefing. However, the DASH translated into Korean and tested for psychometrics is not yet available. Thus, this study was to develop a Korean version of the DASH student version (SV) and test its reliability and validity among baccalaureate nursing students in Korea. METHODS: The participants were 99 baccalaureate nursing students. Content validity using content validity index (CVI), construct validity using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and internal consistency using Cronbach's alpha coefficient were assessed. RESULTS: Both Item-CVIs and Scale-CVI were acceptable. EFA supported the unidimensional latent structure of Korean DASH-SV and results of CFA indicated 6 items converged within the extracted factor, significantly contributing to the factor (p ≤ .05). Items were internally consistent (Cronbach's α = 0.82). CONCLUSION: The Korean version of the DASH-SV is arguably a valid and reliable measure of instructor behaviors that could improve faculty debriefing and student learning in the long term.

Setting Observers Up for Success in Simulation.

BACKGROUND: The assignment to be an observer in simulation is common. Despite evidence that learning outcomes are similar for participants and observers, there is uncertainty among simulation facilitators about how to create a valuable learning experience for learners in observer roles. PROBLEM: The prebriefing practices of establishing a fiction contract and orienting learners to their role are frequently centered on learners in participant roles. APPROACH: Tailoring a fiction contract to the opportunities and challenges that observers experience as well as the use of feedforward to provide specific objectives to learners in observer roles is discussed. CONCLUSIONS: Including specific strategies in the prebriefing for learners in observer roles sets observers up for success in simulation learning experiences.

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.

Linguistic Validation of the Debriefing Assessment for Simulation in Healthcare in Spanish and Cultural Validation for 8 Spanish Speaking Countries.

INTRODUCTION: Debriefing Assessment for Simulation in Healthcare (DASH) is an instrument to assist in developing and evaluating faculty debriefing and instructional skills that, in the context of trained raters, yields reliable data and internal consistency. Support for its validity is grounded in both its content and the scores arising from its use. The utilization of this and other assessment tools, guidelines, and protocols is expanding internationally, but most of them are available only in English and there is not a single established methodology for translation. The objectives of this study were to demonstrate a translation technique and conduct a linguistic validation of the translation of the DASH from English to Spanish and to demonstrate and conduct a cultural validation across 8 Spanish-speaking countries. METHODS: A forward translation and review of the DASH score sheets and Rater's Handbook defined the consensus harmonized version. A backward translation was reviewed by the original authors and discussed with the translators to produce the approved harmonized version. This was then tested through a questionnaire to assess clarity, comprehensiveness, appropriateness, and cultural relevance among 5 monolingual subjects from 8 Spanish-speaking countries. RESULTS: During the forward translation, 16 discrepancies were detected in the Spanish DASH. Sixty-two participants were sent the Spanish cultural questionnaire and 48% responded. A total of 82 different interpretations and 57 extra recommendations (42% terms, 16% concepts, and 42% syntax) were made. Twenty-seven percent of them were applied. CONCLUSIONS: The translated DASH has undergone a linguistic validation into Spanish, and a cultural validation across 8 Spanish-speaking countries. It may be used to assess debriefings in healthcare settings in these countries. The methodology used is applicable for translating and assessing a cross-cultural validation of assessment instruments.

Translation of the Debriefing Assessment for Simulation in Healthcare in Portuguese and cross-cultural adaptation for Portugal and Brazil.

BACKGROUND: Debriefing Assessment for Simulation in Healthcare (DASH©) is an instrument to assist in developing and evaluating debriefing skills. The objectives of this study were to translate the DASH from English to Portuguese and to conduct a cross-cultural adaptation of this translated instrument for Portugal and Brazil. METHODS: A forward translation of the DASH score sheets and Rater's Handbook was accomplished and reviewed by authors from both Portuguese-speaking countries to reach the consensus harmonized version. A backward translation was reviewed by the original authors and discussed with the authors to produce the approved harmonized translation. This was then tested through a questionnaire to assess clarity, comprehensiveness, appropriateness, and cultural relevance among 10 simulation specialists from Portugal and Brazil. RESULTS: During the forward translation, 19 discrepancies were detected in the Portuguese DASH. After backward translation, 7 discrepancies were discussed and harmonized. All 10 simulation specialists from both countries reviewed the harmonized translation and made 70 suggestions, 64 of which were incorporated in the instrument after discussion among authors. CONCLUSIONS: The translated DASH has undergone translation to Portuguese and a cross-cultural adaptation across Portugal and Brazil. It may be used to assess debriefings in healthcare settings in these countries.

Fostering Civility in Learning Conversations: Introducing the PAAIL Communication Strategy.

BACKGROUND: Civility, psychological safety, and effective stress management are essential for meaningful learning conversations. PROBLEM: Incivility triggers fear and humiliation, impairs clinical judgment and learning, reduces psychological safety, and increases cognitive load. These factors converge to make learners less likely to incorporate feedback, speak up when there is a problem, and discuss practice errors and patient safety issues. APPROACH: The authors combined the Basic Assumption and the PAAIL (Preview, Advocacy1, Advocacy2, Inquiry, and Listen) conversational strategy to help surface (rather than obscure) both educators' and learners' thinking. The synergy of these 2 strategies allows educators to identify individual learning needs and develop the learners' clinical judgment skills. This process improves learning by reducing incivility and cognitive load, improving psychological safety, and strengthening clinical judgment skills. CONCLUSION: This conversational strategy can minimize stress and anxiety in learners and optimize learning.

The Changing Landscape of Simulation-Based Education.

: Once considered solely as an educational tool in undergraduate education, simulation-based education (SBE) now has many uses. SBE is now embedded in both graduate and undergraduate nursing education programs and has become increasingly accepted practice in hospital orientation and transition-to-practice programs. Newer applications include ongoing professional education, just-in-time training, teamwork development, and systems testing. This article highlights the changing landscape of SBE and describes elements critical to its successful use, including facilitator competencies, the necessity of providing a psychologically safe environment to enable learning, and the importance of addressing other safety concerns, such as the possibility of accidentally introducing simulated equipment and medications into real patient care.

Structured Debriefing in Simulation-Based Education.

Debriefing following a simulation event is a conversational period for reflection and feedback aimed at sustaining or improving future performance. It is considered by many simulation educators to be a critical activity for learning in simulation-based education. Deep learning can be achieved during debriefing and often depends on the facilitation skills of the debriefer as well as the learner's perceptions of a safe and supportive learning environment as created by the debriefer. On the other hand, poorly facilitated debriefings may create adverse learning, generate bad feelings, and may lead to a degradation of clinical performance, self-reflection, or harm to the educator-learner relationship. The use of a structure that recognizes logical and sequential phases during debriefing can assist simulation educators to achieve a deep level of learning.