Essential Competencies of Preceptors: A Focus on Working with APRN Students

Module 4: Facilitating Critical Thinking and Clinical Decision-Making

Debriefing

Debriefing refers to an active process of rigorous reflection where a situation can be reviewed for discussion to clarify and correct clinical decision making. It has been used widely in the simulation experience and is applicable for use in the precepting environment.

Rudolph, Simon, Rivard, Dufresne, & Raemer (2007) describe debriefing as an iterative process involving frames, actions and results. The frames are our thoughts, actions are our outward response, the results are the outcomes. Reflection at each phase of the experience enhances the role of debriefing with new frames and actions formulated. The arrows below represent debriefing and its impact on frames and actions.

Key components and examples of debriefing:

• There must be debriefing with good judgment that preserves trust and psychological safety in the preceptor - student relationship, but also provides candid insight toward acceptable and accurate actions to affect best outcomes.
• One useful style is to use advocacy (observation or assertion) and inquiry (question to gain insight about action) together. An example of advocacy might be, "I noticed that you did not ask about the quality of the patient's chest pain." An example of inquiry might be," How would the patient's description of their chest discomfort help you to make a prudent clinical decision and plan for diagnostic testing?"
• Debriefing, like other types of feedback, needs to specific and let the student know what was positive about their performance, as well as areas in need of improvement. This is consistent with the One Minute Preceptor model.
• Preceptor feedback may also be shared in a collaborative meeting with faculty and student present if appropriate for learning or to review performance.
• The student feedback is also explored to understand their core knowledge and frames.
• During these sessions, the preceptor reviews the patient assignments, provides suggestions on organization and prioritization, and shares observations made of the nursing student's performance.
• Feedback should be positive and constructive. If positive behaviors are not reinforced, the nursing student may stop these behaviors!

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