April 27, 2020By Dr. Kim Baily

Critical Conversations For Debriefing + Downloadable NLN Guide for Teaching Thinking

In 2015 the National League for Nursing (NLN) in collaboration with the International Nursing Association for Clinical Simulation and Learning (INACSL) sent out a call for action to nursing educators to incorporate debriefing not just in simulation but throughout the curriculum. From that came Critical Conversations for debriefing: The NLN Guide for Teaching Thinking. The guide is a response to the call to action for nurse educators outlined in the NLN vision statement “Debriefing Across the Curriculum”, which encourages nurse educators to let go of their long-held assumptions and reframe how they see the teaching/learning process and the student-teacher relationship. Today, Dr. Kim Baily PhD, MSN, RN, CNE, previous Simulation Coordinator for Los Angeles Harbor College and Director of Nursing for El Camino College, reviews the downloadable NLN Guide for Teaching Thinking, which challenges nursing simulation educators is to shift the emphasis from depositing content into passive learners to using content in realistic settings.

The old idea of pushing as much information into healthcare students as possible using passive strategies has been shown to be ineffective. The new focus or paradigm shift is in the role of the educator as a “facilitator of knowledge co-creation”. Educators should assist learners to reveal the knowledge behind their actions. Faculty should not belittle learners when they make mistakes but rather attempt to understand what the learner was thinking that caused them to behave in a certain way. In such cases faculty might be surprised at the learner’s thinking.

Educators sometimes tell learners what they did wrong and what the “correct” way should be but this does not take the learners thinking into consideration. When learners understand their own thinking, they can attempt to change their thinking which in turn should change the way they practice in the future.

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In 2017, The National League for Nursing published a monograph titled The NLN Guide to Teaching Thinking authored by Susan Gross Forneris and Mary K Fey (Nursing Education Perspectives: 2016. V37, p248-249). The NLN challenged faculty “to shift the emphasis from depositing content into passive learners to using content in realistic settings”. In the monolog, the NLN introduced the concept of critical conversations as a way to enhance debriefing.

The three components of critical conversations context, content and course help educators guide learners to identify what is relevant and meaningful and how to use their knowledge in clinical practice. Critical conversations is not a debriefing method within itself but rather provides a structured way to assist debriefing in already established debriefing methodologies such as Debriefing with Good Judgment, Meaningful Learning and PEARLS.

Context: One sub‐set of constructivism is situated learning theory, which describes a process where ‘knowledge is created and made meaningful by the context in which it is acquired’ (Farmer, Buckmaster, and LeGrand 1992). Learners construct knowledge based on culture, facts, ideals, concepts, rules, principles and existing assumptions. Debriefing should begin by identifying the learner’s context during the simulation by asking students what they know, saw or heard during the simulation, who the patient was and what were their main concerns. The educator can identify relevant data that the learner might have missed. This initial discussion of context forms the basis for the educator to explore the learner’s thinking and knowledge and also to identify the learner’s emotional response to the situation.

Content: This section of debriefing which will be the longest component, should not only identify the learners’ thinking but also the educators so that both learner and educator may understand each other. Kolbe describes this phase as “reflective observation”. During this phase, learners can assign new meaning from the simulation experience and gain new knowledge. Forneris and Fey describe a useful advocacy/inquiry technique for educators to use during this phase. The educator:

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  1. First notes an observation (I noticed that when the patient complained of chest pain, you immediately went to the med cart to pull out nitroglycerin)
  2. Expresses their concern (I am concerned that no additional information about the pain was collected).
  3. Requests the learner to share their thinking at that time (I was wondering what your thoughts were at that time).

This approach seeks to determine why the learner chose a particular course and how the learner makes meaning from a given situation. The educator can share their own meaning and in the process, help the learner see the situation from a different perspective. The educator can lead the learner through the simulation seeking clarification of the learner’s thinking and how they see the situation and then offer alternative meaning to the situation.

Forneris and Fey stress that this part of the conversation between learner and educator must be conducted with mutual trust and respect. Educators should never belittle or intimidate the learners.

Course: During the close of the critical conversation, the educator and learner focus on the future and plan potential actions in the future. The simulation scenario could be related to similar but not identical situations where the learner could apply the new way of thinking they have learned. In the example above, the learner did not complete a thorough pain assessment but jumped from a complaint of chest pain to medication administration without completing a thorough assessment. The group could discuss a similar condition and apply what they have learned.

Critical conversations provide a method to use content in a realistic setting rather than simply providing information to learners in a passive way. Although the focus of this article is simulation, critical conversations can be used in any setting including the classroom and in the clinical setting. The focus is on the learner, what context are they using and what they are thinking.

The educator can use this information to change the meaning a learner applies to a given situation and in so doing, promotes improvement in the learner’s future clinical behaviors. The NLN’s guide for using Critical Conversations; The NLN Guide for Teaching Thinking may be found in the attachment to this article.

Learn More & Download the NLN Debriefing Guide Here!

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