Modeling Crucial Conversations: Debriefing after Simulations

Thursday, 15 July 2010: 4:05 PM

Susan Hayden, RN, PhD
Adult Health Nursing, University of South Alabama, Mobile, AL
Joseph E. Farmer, MSN
Community/Mental Health, University of South Alabama, Mobile, AL

Learning Objective 1: Describe how nurses can effectively handle crucial conversations to improve patient safety.

Learning Objective 2: Discuss debriefing strategies that foster effective communication in a high-stakes patient encounter .

Effective communication remains a formidable challenge for health care professionals and communication failures continue to compromise patient safety and quality of care.  In fact, “Communication breakdowns have long been cited as a root cause in almost every sentinel event reported to The Joint Commission’s Sentinel Event Database and as the leading root cause in a majority of cases studied since 1996” (Nadzam, 2009, p. 184).  Yet, formal training in this area has been lacking, and some suggest “largely absent” (Leonard, Graham, & Bonacum, 2004, p.i85; Manning, 2006).

Nurses encounter individuals and families under duress on a regular basis and participate in discussions “where stakes are high, opinions vary, and emotions are strong” (Patterson, Grenny, McMillan, & Switzler, 2002, p. 3).  Nurses can respond to these situations by avoiding them, facing them and handling them poorly, or facing them and handling them well. Patterson, Grenny, McMillan, and Switzler (2002) describe these discussions as “crucial conversations” and offer a useful dialogue model to guide critical communication. 

High fidelity patient simulation brings patient interactions into the safety of the virtual environment. Student teams can perform in difficult care situations virtually risk-free. Opportunities for crucial conversations can be staged in the simulations, requiring students to face the volatile or controversial conversations.  The debriefing affords an excellent opportunity for faculty to give feedback on the student team’s performance and to explore ways to face the situation and handle it well.  Thispresentation will describe debriefing strategies designed to foster effective communication in a high-stakes patient encounter and explore the use of the dialogue model to model crucial conversations that can avert patient harm caused by communication failures.