NURS 6380 Week 7 stroke case debriefing plan example

The Clock Started at 1410: A PEARLS-Based Debriefing Plan for a Simulation in Which a Hospitalized Woman Develops Sudden Left-Sided Weakness and Slurred Speech

Student Name

College of Nursing, Walden University

NURS 6380: Advanced Pathopharmacology and Health Assessment for Nurse Educators

Instructor Name

Month Day, Year

The Clock Started at 1410: A PEARLS-Based Debriefing Plan for a Simulation in Which a Hospitalized Woman Develops Sudden Left-Sided Weakness and Slurred Speech

Overview

Scenario debriefed: learners are caring for Mrs. Lindqvist, 68, admitted the previous day for pneumonia, who at 1410 cannot lift her left arm and speaks with slurred words when the nurse returns with her afternoon medication. She was last seen normal at 1340, when she ate lunch and chatted with her daughter. The scenario expects learners to recognize a possible stroke, check her glucose, perform a focused neurological assessment, note the time last known well and activate the hospital's stroke response. Mrs. Lindqvist is a teaching composite, not a real patient.

Debriefing objectives: learners will (1) describe why the time last known well determines treatment options, (2) explain the ischemic core and penumbra and why a thrombolytic drug is both time-dependent and bleeding-sensitive, and (3) identify which neurological findings they assessed and which they missed. Model: a blended approach organized in the four phases of the PEARLS framework, reactions, description, analysis and summary, with the facilitator choosing between learner self-assessment, focused facilitation and brief teaching in the analysis phase depending on what the group shows (Eppich & Cheng, 2015). Total time: 35 minutes.

Phase 1: Reactions (3 minutes)

Opening question: "How are you feeling after that?" Allow every learner who wants to speak to answer, including the observers. Acknowledge feelings without evaluating them. If a learner says they felt panicked or froze, reply that this is a common response to a sudden change and that the debrief will look at what helped. Move on when reactions begin to repeat.

Phase 2: Description (5 minutes)

Ask one learner, usually the primary nurse, to summarize what happened in a few sentences. Then confirm the key events with the group, adding any they leave out. Key events the facilitator checks were noticed: the time the weakness was found (1410); the time last known well (1340), which the daughter could confirm; the capillary glucose check; the facial droop and arm drift; the call to the stroke team and the time it was made. If the group did not establish the last known well time, do not correct it here; note it for the analysis phase.

Phase 3: Analysis (22 minutes)

Start with learner self-assessment for 3 minutes: "What aspects of the scenario went well, and what would you change?" Then move to the prepared questions, choosing those the group most needs.

On the time last known well: "When did her symptoms start, as far as treatment is concerned? Why would 1410 and 1340 lead to different decisions?" Teaching point if needed: treatment windows are counted from the time the patient was last known to be well, not from when symptoms were discovered, and guidelines set the eligibility window for intravenous thrombolysis in eligible adults from that time (Powers et al., 2019).

On the core and the penumbra: "Picture the area of brain supplied by the blocked artery. What is happening at the center, and what is happening at the edges?" Teaching point: at the center, the ischemic core, cells die quickly; around it, the penumbra is tissue with reduced blood flow that is not working but can still recover if flow returns. Every minute without reperfusion moves more of the penumbra into the core, which is why the stroke response is a race.

On the thrombolytic: "Why does the drug that could save the penumbra also require the team to rule out bleeding first?" Teaching point: a thrombolytic activates the conversion of plasminogen to plasmin, which breaks down fibrin in the clot, but it does so throughout the body, so it can cause or worsen bleeding, including in the brain. That is why imaging to exclude hemorrhage and a check of bleeding risk come before the dose, and why blood pressure must be controlled.

On the neurological assessment: "Which findings did you assess, and which would you check next time?" Use a plus-delta list on the whiteboard. If nobody mentions the glucose check, the facilitator raises it using advocacy and inquiry: "I noticed the glucose was checked at 1418. I think that matters because low glucose can mimic a stroke. How did you decide when to check it?"

Phase 4: Summary (5 minutes)

Ask each learner for one take-away they will use in practice. The facilitator closes by restating the three points the debrief was built on: the clock starts at the last time the patient was known to be well, the penumbra is what the team is racing to save, and the drug that can save it can also cause bleeding.

Facilitator Note on Psychological Safety

The debriefing process standard asks facilitators to establish a safe environment, follow a planned structure and address performance gaps in a way that supports learning (Decker et al., 2021). In this plan, safety is built in three ways: the reactions phase comes first, so feelings are not left to leak into the analysis; the self-assessment question lets learners name their own gaps before the facilitator does; and missed actions are raised by stating an observation and a reason, followed by a genuine question, rather than by a judgment. Every critical gap, especially a missing last known well time, must be discussed before the session ends, even if learners do not raise it themselves.

References

Decker, S., Alinier, G., Crawford, S. B., Gordon, R. M., Jenkins, D., & Wilson, C. (2021). Healthcare simulation standards of best practice: The debriefing process. Clinical Simulation in Nursing, 58, 27-32. https://doi.org/10.1016/j.ecns.2021.08.011

Eppich, W., & Cheng, A. (2015). Promoting Excellence and Reflective Learning in Simulation (PEARLS): Development and rationale for a blended approach to health care simulation debriefing. Simulation in Healthcare, 10(2), 106-115. https://doi.org/10.1097/SIH.0000000000000072

Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., Biller, J., Brown, M., Demaerschalk, B. M., Hoh, B., Jauch, E. C., Kidwell, C. S., Leslie-Mazwi, T. M., Ovbiagele, B., Scott, P. A., Sheth, K. N., Southerland, A. M., Summers, D. V., & Tirschwell, D. L. (2019). Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke. Stroke, 50(12), e344-e418. https://doi.org/10.1161/STR.0000000000000211