Debriefing Activities Research Articles

Improving Outcomes of Preeclampsia in California: From Review of Maternal Death to Quality Care Collaboratives

Childbearing Poster Presentation Objective To describe characteristics of women in California who died from preeclampsia/eclampsia in 2002 to 2004, identify contributing factors and quality improvement opportunities, and report on process and outcome measures from a multihospital, statewide learning collaborative that implemented a Maternity Care Improvement Preeclampsia Toolkit. Design In 2004, the California Maternal, Child and Adolescent Health Division developed an enhanced surveillance method to identify maternal deaths from administrative data; women's abstracted medical records were reviewed by an expert committee to determine causes of death and opportunities for prevention. Setting Data were collected as part of the California Pregnancy-Associated Mortality Review (CA-PAMR) and from CA-PAMR committee determination after case review. Data collection included classification of pregnancy-relatedness, contributing factors, and quality improvement opportunities. Learning Collaborative participants submitted process and outcomes measures related to the implementation of the Preeclampsia Toolkit. Sample Cases of pregnancy-related deaths (145) from preeclampsia/eclampsia in California between 2002 and 2004 from 26 hospitals in a statewide learning collaborative. Methods Mixed methods analysis was conducted of the CA-PAMR data; Learning Collaborative data were analyzed using frequency and trend charts. Results After case review, 145 maternal deaths from 2002 to 2004 were determined to be pregnancy-related. Preeclampsia was the second leading cause of death accounting for 17% of all pregnancy-related deaths in 2002 to 2004. The women who died from preeclampsia in California from 2002 to 2004 were more likely to be Hispanic, multiparous, and have normal body mass index (BMI) compared to women who died of other pregnancy-related causes. Nearly all ( n = 24/25) of these deaths were determined to have some degree of preventability, with half having a good-to-strong chance. Analysis of the opportunities to improve quality and reduce preventable maternal deaths revealed themes related to the need for recognition and response to clinical triggers (i.e., warning signs) in clinical status and care coordination. Learning collaborative participants reported increased levels of awareness and education regarding the importance of treating severe hypertension in pregnant women as a result of debriefing activity. Sites improved methods for medical chart documentation and coding, and overall data quality improvements as they apply to women with hypertensive disorders, including preeclampsia. Conclusion/Implications for Nursing Practice Implementation of the Preeclampsia Toolkit in the multihospital, statewide Learning Collaborative is intended to reduce rates of severe maternal morbidity and prolonged postpartum length of stay. Learning Collaborative participants who adopted the Toolkit showed measurable improvement in the ability of their sites to respond to this leading cause of pregnancy-related morbidity and mortality.

Problem-based learning for professionalism and scientific integrity training of biomedical graduate students: process evaluation

ObjectiveWe conducted a process evaluation to (a) assess the effectiveness of a new problem-based learning curriculum designed to teach professionalism and scientific integrity to biomedical graduate students and (b) modify...

Debriefing with the OPT Model of Clinical Reasoning during High Fidelity Patient Simulation

Evidenced-based educational practices propose simulation as a valuable teaching and learning strategy to promote situated cognition and clinical reasoning to teach nursing students how to solve problems. A project that uses a structured debriefing activity, the Outcome Present State-Test Model of clinical reasoning following high fidelity patient simulation, is described in this paper. The results of this project challenge faculty to create and manage patient simulation scenarios that coordinate with didactic content and clinical experiences to direct student learning for the best reinforcement of clinical reasoning outcomes. Considerations for the future include incorporating patient simulation activities as part of student evaluation and curriculum development. The arguments for using high fidelity patient simulation in the current educational environment has obvious short term benefits, however, the long term benefit of developing clinical expertise remains to be discovered.

Briefing and debriefing of student fieldwork experiences: Exploring concerns and reflecting on practice

This paper describes a briefing and debriefing process used with occupational therapy students. Without a briefing and debriefing component of fieldwork experiences, there is a potential for fieldwork not to be fully integrated into the curriculum. An example of one briefing activity and one debriefing activity are presented. The briefing activity was designed to explore the perceptions and concerns of students at each stage of the course about imminent fieldwork placements. The debriefing activity investigated second‐year student perspectives about valued characteristics of supervisors and students. Written data generated during each activity were analysed using qualitative strategies. Specific concerns for students related to each year of the occupational therapy course were identified. Positive and negative student reflections about their fieldwork supervision were expressed. The value of the fieldwork briefing and debriefing process to enhance student learning is discussed.

You're in the Hot Seat: An Ethical Decision-Making Simulation for Counseling Students

In the counseling field, students in counseling ethics courses often have difficulty making appropriate choices in case study situations. Using Hypercard 2.2, a counseling ethics computer simulation tool was designed to address this need. The simulation enables students to consider their actions in realistic ethical counseling dilemmas and then to reflect on their decision-making processes. Classroom debriefing activities assist students in improving their ethical decision making. The simulation provides ethical decision-making practice and motivates students to take seriously the ethical dimensions of their future roles as professional counselors.