The Power of the Pre-Brief

National League of Nursing Simulation Leaders: Teresa Britt MSN, RN, CHSE Rachel Onello, PhD, RN, CHSE, CNE, CNL; Katie Robinson, MSN, RN Connie K. Smith, MSN, RN, CNE, CHSE;

Objectives Discuss the definitions of pre-briefing. Identify interventions that the process of pre-briefing should include. Review available pre-briefing resources.

Simulation-Based Learning (SBL): Experiences using full scale computerized patient simulators, virtual reality or standardized patients that are extremely realistic and provide a high level of interactivity and realism for the learner

Over the last 20 years, SBL has evolved as pedagogy across many disciplines such as aviation, medicine, and nursing where experiential learning and critical reflection in a safe controlled environment is of great benefit.

Simulation-based learning : students can practice cognitive, interpersonal, and psychomotor skills, make clinical judgments, and demonstrate critical thinking during patient care (Gaba, 2004).

Typically, the SBL experience consists of a prebriefing period, a simulated clinical patient scenario, and a debriefing period (Jeffries, 2012).

Simulation Standards of Best Practice In 2011, the INACSL Board of Directors developed the Standards of Best Practice for Simulation. Implementation guidelines for the standards were further developed in 2013 (International Nursing Association for Clinical Simulation and Learning Board of Directors, 2013).

According to these standards, prebriefing was defined as: An information session held prior to the start of a simulation activity and in which instructions or preparatory information is given to participants. The purpose of the prebriefing is to set the stage for a scenario and assist participants in achieving scenario objectives. Suggested activities in a prebriefing include an orientation to the equipment, environment, manikin, roles, time allotment, objectives, and patient situation. (Meakim et al., 2013, p. s5)

Briefing Definitions An activity immediately preceding the start of a simulation activity where the participants receive essential information about the simulation scenario such as background information, vital signs, instructions, or guidelines. For example: before beginning a session, faculty conduct a briefing about the scenario to review the information being provided to the participants. ( SSiH Dictionary)

Our Learners Before Simulation

Basic Assumption This term was created by the Center for Medical Simulation at Harvard- Identifies that the participant is expected to perform as if this is a real situation; that the “host” will provide as real a situation as possible, that there will be mutual respect in all stages of the activity; that participants will perform their best, just as they would in an actual clinical setting.

Fiction Contract Actual signed document that identifies learner and facilitator responsibilities https://meded.ucsd.edu/assets/66/File/Simulation%20Fiction%20Contract.pdf

Participant Anxiety According to a literature review by Nielsen and Harder (2013), simulation frequently causes anxiety for students, which may interfere with their learning. Not knowing what to expect Feeling unprepared Dislike performing when others can view their actions

“ Safe Container” and Psychological Safety ( Rudolph, et al, 2014) Establishing a psychologically safe context includes the practices of (1) clarifying expectations, (2) establishing a "fiction contract" with participants, (3) attending to logistic details, and (4) declaring and enacting a commitment to respecting learners and concern for their psychological safety. As instructors collaborate with learners to perform these practices, consistency between what instructors say and do may also impact learners' engagement. ( Rudolph, et al , 2014)

Role–modeling during the Pre-Brief? Skill practice prior to the session Discussing and planning care strategies prior to participation ( pre-conference) Actually demonstrating or providing examples very similar to the activity expected of the participants/ learners

Preparation for the experience- is this part of the pre-brief? Reviewing case information with all faculty facilitators Performing a dry run/ dress rehearsal of the scenario case Testing all rubrics/ scoring metrics for inter-rater reliability Materials that participants read and complete prior to session

Setting the Parameters- What Should be Included? Orientation to the environment Reviewing the objectives for the session Identifying the setting What resources are available during the scenario and how they work if needed Discussing roles and scope of activities Projected time limit for the session

Parameters ( cont) Confidentiality How to determine assessment data Storage of supplies and any needed equipment Communication methods such as phones, call lights, intercoms. Statements regarding mutual trust and safe learning environment

Parameters (cont) Functionality of the mannequin Use of video Logistics and debriefing

Scripted Briefing

Pre-Briefing Summary Points Pre-Briefing an important part of the simulation pedagogy Need to allot time ( more time for more novice participants) Facilitator should prepare briefing materials as part of the case/ simulation activity

Quality Brief Leads to Quality Simulation Activity

Is this your image of a brief?

What are pre-briefing activities at your institution? What do you think pre-briefing components should include?

Faculty Resources Simulation Faculty Development Repository

References Bye, B. (2014). Interactive pre-simulation strategies: Engaging students in experiential learning from the start. Systemics, Cybernetics, and Informatics, 12(1), 69-75. Chamberlain, J. (2015). Prebriefing in nursing simulation: A concept analysis using Rodger’s methodology. Clinical Simulation in Nursing, 11(7), 318-322. Chamberlain, J. (2016). The impact of prebriefing phase on undergraduate nursing education. Doctoral Dissertation: Nova Southeastern University. ProQuest number:1004296. Edmondson, A., & Lei, Z. (2014). Psychological safety: The history, renaissance, and future of an interpersonal construct. The Annual Review of Organizational Psychology and Organizational Behavior, 1, 23-43. Hayden, J.K., Smiley R.A., Alexander, M.A., Kardong-Edgren, S., & Jeffries, P.R. (2014). The NCSBN National Simulation Study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2 Suppl), S1-S64.

International Nursing Association for Clinical Simulation and Learning [INACSL]. (2015). Standards of Best Practice: Simulation. Available at: http://www.inacsl.org/i4a/pages/index.cfm?pageid=3407 McDermott, D.S. (2016). The prebriefing concept: A Delphi study of CHSE experts. Clinical Simulation in Nursing, 12(6), 219-227. National League for Nursing. (2015). A Vision for Teaching with Simulation. Available at: http://www.nln.org/about/position-statements/nln-living-documents Page-Cutrara, K. (2014). Use of pre-briefing in nursing simulation: A literature review. Journal of Nursing Education, 53(3), 136-141. Rudolph, JW, Raemer, DB, Simon, R. (2014). Establishing a safe container for learning in simulation. Simulation in Healthcare, 9, 339-349. Waxman, K.T. (2010). The development of evidence-based clinical simulation scenarios: Guidelines for nurse educators. Journal of Nursing Education, 49(1), 29-35.

Thank You! The Sim Leaders on this project would like to express their heartfelt appreciation to Dr. Mary Anne Rizzolo and Dr. Sue Forneris for their guidance and support; as well as our project mentor, Dr. Cathy Coram.