In nursing education, debriefing after clinical – whether in person or in simulation – is essential. It is a time where educators provide feedback, analyze actions, and encourage reflections to improve future performance (Fegran et al., 2023). It is a process that must be intentional and should encourage students to “know what,” “know how,” and “know why” (Lippincott Nursing Education, 2018).

Goals of Debriefing (Jett, 2023)

Foster a safe learning environment

It is important for students to know that they are in a safe space when they are debriefing, where psychological safety is prioritized, and privacy and confidentiality are maintained.

Link the simulation to learning objectives, which then feed to learning outcomes

Debriefing is a time to “pull it all together” and allow the student to make connections between didactic learning and what they experience during clinicals and simulation.

Opportunity for feedback, involvement, behavior, & clinical judgement

During debriefing, the faculty member or instructor can provide feedback and help the student work through the thoughts behind their decision-making and actions.

Reflection

This is an opportunity for students to review the case or situation and look back on their actions and interactions. Serious thought can follow to help them understand the “why” behind their actions.

Growth

Debriefing is often the time where students have those “Ah-ha” moments where things start to come together!
 

“This isn't a time to reteach. This isn’t the time to lecture. This is a time to understand that doorway to decision, that path to why they did something and help them critically think and clinically judge that situation to make better decisions or to make the good decisions again. That's really the heart and soul of it.”
--Katie Jett, DNP, RN, MSN, FNP-BC; Associate Professor and Undergraduate Program Director at Goldfarb School of Nursing at Barnes-Jewish College in St. Louis, MO 

 

6 Debriefing Models

Debriefing for Meaningful Learning^© (Dreifuerst, 2015)

Debriefing for Meaningful Learning^© emphasizes reflective thinking. This model uses Socratic questioning and principles of active learning to uncover thinking associated with actions. It helps to develop clinical reasoning skills and help students become reflective practitioners.

3D Model of Debriefing (Zigmont et al., 2011)

The 3D Model of Debriefing includes three sections: defusing, discovering, and deepening. It incorporates common phases prevalent in the debriefing literature, including description of and reactions to the experience, analysis of behaviors, and application or synthesis of new knowledge into clinical practice. It can be used to enhance learning after real or simulated events.

Plus-Delta Debriefing (Cheng et al., 2021)

The Plus/Delta model of debriefing emphasizes questions such as “What went well and what would you do differently next time?”; “What did you do well, and what did not go well, and why?”; or “What was easy and what was challenging for you?” This approach promotes learners’ capacity for a self-assessment.

Advocacy Inquiry (Castillo, 2023)

The advocacy-inquiry model is an approach to cultivate a constructive conversation. In this framework, an advocacy statement is used to make an objective observation and is followed by an inquiry to help identify the thought processes and beliefs that inform the student’s actions. Active listening and targeted teaching to offer alternative paths and resources are prioritized.  

Practitioners of Debriefing with Good Judgment^© (Buttimer, n.d.)

This method uses advocacy-inquiry as a conversational strategy to explore what students were thinking during specific points in simulations, using the mnemonic PAAIL:
Preview – State what you’d like to talk about
Advocacy – I saw (state what was observed, in objective terms)
Advocacy – I think (your perspective and the impact of the observed behavior)
Inquiry – I wonder (ask what was on the student’s mind at the time)
Listen – To understand the frames behind the observed action

PEARLS (Eppich and Cheng, 2015)

The PEARLS (Promoting Excellence and Reflective Learning in Simulation) framework integrates three common educational strategies: learner self-assessment, focused facilitation (including advocacy-inquiry), and providing information or direct feedback/teaching. A tool to make this framework more accessible as a cognitive aid and that supports educator training can be downloaded here.
 
If you have another tool or tips to help with debriefing, please let us know by leaving a comment! Thank you!

References:
Bajaj, K., Meguerdichian, M., Thoma, B., Huang, S., Eppich, W., & Cheng, A. (2018). The PEARLS Healthcare Debriefing Tool. Academic medicine: journal of the Association of American Medical Colleges, 93(2), 336. https://doi.org/10.1097/ACM.0000000000002035

Buttimer, M. (n.d.). PAAIL: A Conversational Strategy. Center for Medical Simulation. https://harvardmedsim.org/blog/paail-a-conversational-strategy/

Castillo, A. Y., Chan, J. D., Lynch, J. B., & Bryson-Cahn, C. (2023). How to disagree better: utilizing advocacy-inquiry techniques to improve communication and spur behavior change. Antimicrobial stewardship & healthcare epidemiology : ASHE, 3(1), e201. https://doi.org/10.1017/ash.2023.457

Cheng, A., Eppich, W., Epps, C., Kolbe, M., Meguerdichian, M., & Grant, V. (2021). Embracing informed learner self-assessment during debriefing: the art of plus-delta. Advances in simulation (London, England), 6(1), 22. https://doi.org/10.1186/s41077-021-00173-1

Dreifuerst, K. (2015). Getting started with debriefing for meaningful learning. Clinical Simulation in Nursing. https://doi.org/10.1016/j.ecns.2015.01.005

Eppich, W., & Cheng, A. (2015). Promoting Excellence and Reflective Learning in Simulation (PEARLS): development and rationale for a blended approach to health care simulation debriefing. Simulation in healthcare : journal of the Society for Simulation in Healthcare, 10(2), 106–115. https://doi.org/10.1097/SIH.0000000000000072

Fegran, L., Ten Ham-Baloyi, W., Fossum, M., Hovland, O. J., Naidoo, J. R., van Rooyen, D. R. M., Sejersted, E., & Robstad, N. (2023). Simulation debriefing as part of simulation for clinical teaching and learning in nursing education: A scoping review. Nursing open, 10(3), 1217–1233. https://doi.org/10.1002/nop2.1426

Jett, K. (2023). Implementing Debriefing to Enhance Reflection and Clinical Judgement. Lippincott Nursing Education Innovation Summit.

Jett, K. (2023). Debriefing: It Should Always Be About the Learner. Lippincott NursingCenter interview: https://www.nursingcenter.com/journals-articles/video-library/debriefing

Laerdal. (2024). 5 Most Important Debriefing Questions for Nursing Simulation. https://laerdal.com/information/5-most-important-debriefing-questions-for-nursing-simulation/

Lippincott Nursing Education. (2018, May 1). The 411 on debriefing in clinical simulation: How nursing simulations & debriefing create better nurses. Wolters Kluwer. http://nursingeducation.lww.com/blog.entry.html/2018/04/30/debriefing_clinical-22AD.html

Zigmont, J. J., Kappus, L. J., & Sudikoff, S. N. (2011). The 3D model of debriefing: defusing, discovering, and deepening. Seminars in perinatology, 35(2), 52–58. https://doi.org/10.1053/j.semperi.2011.01.003

 

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