6 debriefing models in nursing education

In nursing education, debriefing after a clinical examination – each in person and in simulation – is crucial. It is a time when teachers provide feedback, analyze actions, and encourage reflection to enhance future performance (Fegran et al., 2023). It is a process that should be intentional and may encourage students to “know what,” “understand how,” and “know why” (Lippincott Nursing Education, 2018).

Summary Objectives (Jett, 2023)

Maintain a secure learning environment

It will be significant that students know that in debriefing they’re in a secure space where psychological safety is a priority and privacy and confidentiality are maintained.

Connect the simulation to learning objectives, which then translate into learning outcomes

Debriefing is a time to “put all of it together” and permit the coed to attach didactic learning to what they experience during clinical activities and simulations.

Opportunities for feedback, engagement, behavior and clinical judgment

During a debrief, the lecturer or instructor can provide feedback and help the coed review the pondering behind his or her decision-making and actions.

Reflection

That is a possibility for college students to review a problem or situation and look back on their actions and interactions. Serious thought might help them understand the “why” of their actions.

Growth

Debriefing is usually a time where students have “aha” moments where all the things starts to come back together!

–Katie Jett, DNP, RN, MSN, FNP-BC; Associate Professor and Director of the Undergraduate Program on the Goldfarb School of Nursing at Barnes-Jew College in St. Louis, MO

6 summary models

Summary for meaningful learning^© (Dreifuerst, 2015)

Summary for meaningful learning^© emphasizes reflective pondering. This model uses Socratic questioning and energetic learning principles to uncover pondering related to motion. Helps develop clinical reasoning skills and helps students turn into reflective practitioners.

Summary 3D model (Zigmont et al., 2011)

The 3D summary model includes three sections: defuse, explore and deepen. It covers the everyday phases prevalent within the debriefing literature, including description of and response to experience, evaluation of behavior, and application or synthesis of recent knowledge in clinical practice. It may well be used to boost learning from real or simulated events.

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

The Plus/Delta debriefing model emphasizes questions akin to or. This approach promotes students’ ability to self-assess.

Advocacy Inquiry (Castillo, 2023)

The Advocacy and Inquiry Model is an approach to cultivating constructive conversation. On this context, a supporting statement serves as an objective remark, followed by an inquiry that helps discover the thought processes and beliefs that influence the coed’s actions. We prioritize energetic listening and targeted learning to supply alternative pathways and resources.

Debriefing practitioners with common sense^© (Buttimer, n.d.)

This method uses advocacy inquiry as a conversational technique to explore what students were pondering at specific moments within the simulation, using the mnemonic PAAIL:
review – specify what you want to to discuss
dvocacy – I saw (present what was observed objectively)
dvocacy – I feel (your perspective and the impact of observed behavior)
inquiry – I’m wondering (ask what the coed had in mind on the time)
isten – To grasp the framework of the motion being observed

PEARLS (Eppich and Cheng, 2015)

The PEARLS (Promoting Excellence and Reflective Learning in Simulation) framework integrates three common learning strategies: learner self-assessment, targeted facilitation (including inquiry for support), and provision of knowledge or direct feedback/teaching. A tool may be downloaded to make this framework more accessible as a cognitive aid and to support teacher training Here.

If you might have one other tool or tip to assist you to summarize, tell us by leaving a comment! Thanks!

Bajaj, K., Meguerdichian, M., Thoma, B., Huang, S., Eppich, W., and Cheng, A. (2018). PEARLS Healthcare Summary Tool. , (2), 336. https://doi.org/10.1097/ACM.0000000000002035

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

Castillo, A. Y., Chan, J. D., Lynch, J. B., & Bryson-Cahn, C. (2023). The way to disagree higher: Using counseling techniques to enhance communication and stimulate behavior change. Antimicrobial stewardship and healthcare epidemiology: ASHE, 3(1), e201. https://doi.org/10.1017/ash.2023.457

Cheng, A., Eppich, W., Epps, C., Kolbe, M., Meguerdichian, M., and Grant, V. (2021). Incorporating informed student self-assessment during debriefing: The art of plus-delta. , (1), 22. https://doi.org/10.1186/s41077-021-00173-1

Dreifuerst, K. (2015). Starting with a summary for meaningful learning. Clinical simulation in nursing. https://doi.org/10.1016/j.ecns.2015.01.005

Eppich, W., and 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 Health Care: Journal of the Society for Simulation in Health Care, 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., and Robstad, N. (2023). Simulation summary as a part of simulation in clinical teaching and learning in nursing education: A scoping review. , (3), 1217–1233. https://doi.org/10.1002/nop2.1426

Jett, K. (2023). Implement debriefing to boost reflection and clinical judgment. Lippincott Nursing Education Innovation Summit.

Jett, K. (2023). Summary: It should all the time be in regards to the student. Interview with Lippincott NursingCenter: https://www.nursingcenter.com/journals-articles/video-library/debriefing

Laerdal. (2024). The 5 most significant nursing simulation summary questions. 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 and Debriefing Create Higher 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 three-dimensional debriefing model: disarming, discovering, and deepening. , (2), 52–58. https://doi.org/10.1053/j.semperi.2011.01.003