--- title: "The debrief carries the effect: scenario and debrief design" description: "Debriefed groups outperformed controls by about 25% across 46 samples. What the evidence says on scenario design, debrief length, prebriefs and co-design." canonical: https://peopletechrevolution.com/insights/design-de-escalation-scenario-debrief --- [Insights](https://peopletechrevolution.com/insights) # The debrief carries the effect: what the evidence says about scenario and debrief design Across 46 samples, debriefed groups outperformed controls by about 25% (d = 0.67), Tannenbaum and Cerasoli, Human Factors, 2013. By [Kim Loza](https://linkedin.com/in/kimberlyloza), Head of Product at People Tech Revolution Published 25 September 2026 · Last updated 28 September 2026 · Version 2.0 [Connect with Kim on LinkedIn ↗](https://linkedin.com/in/kimberlyloza) Cite this research 0.67 debrief effect across 46 samples Tannenbaum and Cerasoli, 2013 0.68 skills effect for a range of difficulty Cook et al., 289 studies, 2013 138.8 violent-act cases per 10,000, psychiatric hospitals BLS Table R8, 2023-24 5 of 1,227 MedEdPORTAL titles naming de-escalation or aggression PubMed, read September 2026 Where the risk sits ## Which settings should the opening scenarios mirror? The settings where violence concentrates: in 2023-24, US psychiatric hospitals recorded 138.8 violent-act injury cases per 10,000 full-time workers, against 3.4 in ambulatory care. A simulated community mental health room. A man waits on the footpath. A relative gestures beside a facilitator. Violent-act injury cases per 10,000 full-time workers, US, 2023-24 Psychiatric hospitals 138.8 Residential disability and mental health 60.9 Nursing and residential care 26.5 Hospitals, all 18.3 General hospitals 14.9 All health care and social assistance 11.9 Home health care 3.7 Ambulatory care 3.4 All private industry 2.6 See the data (cases per 10,000) Measure Cases per 10,000 Psychiatric hospitals 138.8 Residential disability and mental health 60.9 Nursing and residential care 26.5 Hospitals, all 18.3 General hospitals 14.9 All health care and social assistance 11.9 Home health care 3.7 Ambulatory care 3.4 All private industry 2.6 Cases with days away from work per 10,000 full-time workers, 2023-24 annualised. Source: [BLS Table R8](https://www.bls.gov/iif/nonfatal-injuries-and-illnesses-tables/case-and-demographic-characteristics-table-r8-2023-2024.xlsx). ### Psychiatric hospitals run 40.8 times the ambulatory rate That is 11.7 times the sector rate of 11.9; residential disability and mental health follow at 60.9. So what for you: Set the opening scenarios in inpatient mental health and residential care. A ward round seen from inside the headset. ### The order holds on a wider count Adding restricted-duty cases, psychiatric hospitals reach 204.5 per 10,000 and residential facilities 84.6, against 17.6 for the sector. On the 2018 coding, psychiatric hospitals stood at 124.9 ([BLS](https://www.bls.gov/iif/factsheets/workplace-violence-healthcare-2018.htm)). The other person ## Who is the other person in the scenario? Usually a patient, relative or member of the public: in 2025, 14.47% of NHS staff in England reported physical violence from them, against 1.80% from colleagues. NHS staff reporting physical violence, by source, England, 2021 to 2025 From patients, relatives or the public From other colleagues From managers See the data (percent of staff) 2021 2022 2023 2024 2025 From patients, relatives or the public 14.57% 14.82% 13.88% 14.38% 14.47% From other colleagues 1.59% 1.77% 1.73% 1.89% 1.80% From managers 0.66% 0.78% 0.72% 0.78% 0.75% Percent of staff, last 12 months, 2021 to 2025. Source: [NHS Staff Survey briefing 2025](https://www.nhsstaffsurveys.com/static/98fbf017ea18aad1523254e02072cd02/National-Results-Briefing-2025.pdf). ### Violence from the public ran about 8.0 times the colleague rate The public share held between 13.88% and 14.82% for 5 years; colleagues sat at 1.59% to 1.89%, managers 0.66% to 0.78%. So what for you: Cast the other person as a patient, relative or visitor, and keep a colleague case. NHS staff reporting physical violence from the public, by staff group, England, 2025 Ambulance (operational) 38.04% Nursing and healthcare assistants 34.33% Registered nurses and midwives 22.58% All staff 14.47% Social care 13.29% Medical and dental 11.68% Allied health professionals 9.12% Wider healthcare team 3.02% See the data (percent of staff) Measure Percent of staff Ambulance (operational) 38.04% Nursing and healthcare assistants 34.33% Registered nurses and midwives 22.58% All staff 14.47% Social care 13.29% Medical and dental 11.68% Allied health professionals 9.12% Wider healthcare team 3.02% Percent of staff, last 12 months, 2025. Source: [NHS Staff Survey 2025 detailed spreadsheets](https://www.nhsstaffsurveys.com/). ### Ambulance crews and nursing assistants report it most 38.04% of ambulance staff and 34.33% of nursing and healthcare assistants reported it, against 14.47% of all staff. So what for you: Write ambulance and nursing assistant scenarios with people from those roles. The debrief ## Does a debrief add anything to the scenario itself? A measurable amount: across 46 samples, debriefed groups outperformed controls by about 25%, and later meta-analyses of structured debriefs report d = 0.79 and 0.92. Effect sizes for the debrief and the practice around it Debrief against none (2013) 0.67 After-action review (2021) 0.79 After-action review (2022) 0.92 Deliberate practice (2011) 0.71 Video added to the debrief (2014) 0.10 See the data (effect size) Measure Effect size Debrief against none (2013) 0.67 After-action review (2021) 0.79 After-action review (2022) 0.92 Deliberate practice (2011) 0.71 Video added to the debrief (2014) 0.10 Standardised effect size, 2011 to 2022. Source: [Tannenbaum and Cerasoli](https://doi.org/10.1177/0018720812448394); [Keiser and Arthur](https://doi.org/10.1037/apl0000821); [Keiser and Arthur](https://doi.org/10.1007/s10869-021-09784-x); [McGaghie et al.](https://doi.org/10.1097/ACM.0b013e318217e119); [Cheng et al.](https://doi.org/10.1111/medu.12432). ### The debrief carries an effect of its own Structured debriefs show 0.67 to 0.92 across fields; adding video showed 0.10, which the review calls negligible. So what for you: Give every session debrief time and a trained facilitator before adding playback. A facilitator turns over a feedback card. ### Most published debriefs are thinly described A [2014 review](https://doi.org/10.1111/medu.12432) found 177 studies, with 11,511 learners, pairing simulation with a debrief. Against no intervention, effects ran from 0.28 to 2.16; duration and structure were usually incompletely reported. A facilitator and participant discuss an exchange. ### Where a debrief does most In a [2022 meta-analysis](https://doi.org/10.1007/s10869-021-09784-x) (overall d = 0.92), the largest effects came on complex tasks that give no feedback of their own. A separate reaction phase or a canned performance review added little. A participant talks it through with a facilitator. ### Structure and scripts A [2015 review](https://doi.org/10.1177/0310057X1504300303) found one generalisable study, of scripted debriefing run by novice instructors. In healthcare, highly and loosely structured reviews performed comparably ([Keiser and Arthur, 2021](https://doi.org/10.1037/apl0000821), overall d = 0.79 across all samples). A family support worker sits with a woman. ### Gains measured inside the scenario A [Cochrane review](https://doi.org/10.1002/14651858.CD011860.pub2) found training may raise knowledge (SMD 0.86); skills were very uncertain (0.21) and the long-term effect on aggression unclear (risk ratio 1.14). [Price and colleagues](https://doi.org/10.1192/bjp.bp.114.144576) found the strongest effects in artificial training scenarios. Debrief models ## Which debrief model should a program use? A model the facilitators can run the same way every time: common structures move from reaction to analysis to summary. Feedback cards sorted on a table. A coach and learner arrange markers. A facilitator briefs participants in a workshop. A practitioner discusses feedback with a coach. ### PEARLS and plus-delta [PEARLS](https://doi.org/10.1097/SIH.0000000000000072) blends learner self-assessment, focused facilitation and directive feedback, with a scripted tool. Plus-delta asks what went well and what to change, a self-assessment method ([Sawyer et al.](https://doi.org/10.1097/SIH.0000000000000148)). A facilitator and a colleague rehearse. ### Advocacy with inquiry [Rudolph and colleagues](https://doi.org/10.1097/01266021-200600110-00006) combine what the facilitator saw with a curious question about the learner’s reasoning, “debriefing with good judgment”; [AHRQ’s dictionary](https://www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/resources/simulation/sim-dictionary-3rd.pdf) defines advocacy-inquiry the same way. A charge nurse briefs nurses at a ward station. ### The TeamSTEPPS debrief checklist [AHRQ’s Pocket Guide](https://www.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/teamstepps-pocket-guide.pdf) lists 10 items: communication clear; roles understood; situation awareness maintained; workload equitable; task assistance requested or offered; errors made or avoided; resources available; what went well; what should improve; what to do differently. Debrief length ## How long should the debrief run? Long enough for the objectives: effective video-debrief studies ran 10 to 90 minutes, and no measured comparison ties debrief length to scenario length. Curated sources laid out for review. ### Tracing the ratio rule The rule of 2 to 3 times the scenario is often credited to [Fanning and Gaba (2007)](https://doi.org/10.1097/SIH.0b013e3180315539), whose full text holds no ratio; it reports crew debriefings averaging 31 minutes. Facilitators hand over a practice session. ### Where the ratio comes from [Bae and colleagues](https://doi.org/10.1186/s12909-019-1633-8) trace it to a 2010 book chapter and ran a 1 hour debrief after a 30 minute scenario. Others cite a paywalled 2010 article ([a 2023 paramedic paper](https://doi.org/10.29045/14784726.2023.3.7.4.51)) or set a minimum of the scenario length ([StatPearls](https://www.ncbi.nlm.nih.gov/books/NBK549876/)). A learner repeats a quiet task. ### What was measured A [2024 study](https://doi.org/10.1371/journal.pone.0299049) ran a 40 minute debrief at 2 times its scenario. [Cheng and colleagues](https://doi.org/10.1111/medu.12432) found short debriefs with expert modelling ahead of long ones (ES 0.21 to 0.74), a difference the review does not treat as established. Design features ## Which design features are worth building? Difficulty levels, repetition and interactivity: across 289 comparative studies they pooled 0.65 to 0.68 on skills, while higher fidelity added 1% to 2%. Pooled skills effect by design feature, number of studies in brackets Range of difficulty (20) 0.68 Repetitive practice (7) 0.68 Distributed practice (6) 0.66 Interactivity (89) 0.65 Multiple learning strategies (70) 0.62 Individualised learning (59) 0.52 Mastery learning (3) 0.45 Feedback (80) 0.44 Longer time (23) 0.34 Clinical variation (16) 0.20 Group training (8) −0.22 See the data (effect size) Measure Effect size Range of difficulty (20) 0.68 Repetitive practice (7) 0.68 Distributed practice (6) 0.66 Interactivity (89) 0.65 Multiple learning strategies (70) 0.62 Individualised learning (59) 0.52 Mastery learning (3) 0.45 Feedback (80) 0.44 Longer time (23) 0.34 Clinical variation (16) 0.20 Group training (8) −0.22 Pooled effect size, skills; positive favours the feature, published 2013. Source: [Cook et al., Medical Teacher](https://doi.org/10.3109/0142159X.2012.714886). ### Difficulty, repetition and spacing show the largest effects Clinical variation (0.20) and group training (−0.22) showed no clear gain, and mastery learning rests on 3 studies. So what for you: Write each scenario at several difficulty levels and plan spaced repeats. A facilitator stands among decision zones. ### Realism adds little measured learning Across 24 studies, [Norman and colleagues](https://doi.org/10.1111/j.1365-2923.2012.04243.x) found high-fidelity simulation ahead of low fidelity by 1% to 2% on average. Against no practice, simulation showed a knowledge effect of 1.20 across 35,226 trainees ([Cook, 2011](https://doi.org/10.1001/jama.2011.1234)). Observers watch a headset rehearsal. ### Practice beats a lecture Deliberate practice outperformed traditional clinical education across [14 studies](https://doi.org/10.1097/ACM.0b013e318217e119) (0.71). In a [2026 review](https://doi.org/10.1093/acamed/wvag026), 12 of 56 studies rated strong, and each combined teaching with role-play or simulation. A man waits at the triage counter. A receptionist waits as a man approaches. A resident raises a concern at a counter. A facilitator stands at the centre of a scene. ### Headset, live role-play or branching In a [2023 police study](https://doi.org/10.1093/police/paad069), VR and live-action scenarios each outscored control, with VR comparable to live action. A [2026 review](https://pmc.ncbi.nlm.nih.gov/articles/PMC12917911/) of VR formats found none of its 15 studies evaluated organisational impact; searches found no branching against linear comparison. A facilitator adjusts a headset for a learner. ### How often to repeat [OSHA](https://www.osha.gov/Publications/osha3148.pdf) says high-risk settings may need refreshers “perhaps monthly or quarterly”. A [2025 meta-analysis](https://doi.org/10.1111/inr.70107) (SMD 0.85) suggests repeated practice may outperform lectures, without testing it. Prebrief ## What should happen before the scenario starts? A prebrief on expectations, roles and safety: a 2022 meta-analysis found a larger collaboration effect with a prebrief (0.82 against 0.27). Collaboration effect in nursing simulation, with and without a prebrief With a prebrief 0.82 Without a prebrief 0.27 See the data (effect size) Measure Effect size With a prebrief 0.82 Without a prebrief 0.27 Standardised effect size, studies to June 2022. Source: [Tong et al., Nurse Education Today](https://doi.org/10.1016/j.nedt.2022.105609). ### A prebrief showed its gain on collaboration The gap held across 4,926 students in 42 studies (p = 0.004); knowledge, skill and 5 other outcomes did not differ. So what for you: Aim the prebrief at the team: roles, ground rules and how to call for help. A simulated briefing room with a window. ### What the standard asks for The [INACSL prebriefing standard](https://doi.org/10.1016/j.ecns.2021.08.008) prepares learners for the content and ground rules; its [2025 revision](https://doi.org/10.1016/j.ecns.2025.101777) adds roles, psychological and physical safety, confidentiality and the fiction contract. A facilitator beside a headset on a stand. ### A headset needs its own orientation A [2024 review](https://doi.org/10.1097/NNE.0000000000001477) of VR and AR prebriefs found orientation and time handled inconsistently. Across 21 studies, preparation and briefing showed positive effects on satisfaction and knowledge ([Tyerman et al.](https://doi.org/10.1016/j.ecns.2018.11.002)). Safety in the room ## How do we keep practice safe for staff with a real incident history? Plan it into the prebrief and debrief, so staff can speak up and ask for help while the scenario keeps its challenge. A clinician sits with a young woman outside. An observer and a participant share a room. A palliative care nurse talks with a visitor. A practitioner rehearses beside a facilitator. ### Discomfort is part of the design A [review](https://doi.org/10.1186/s12912-025-03575-y) that screened 2,071 records found psychological safety in simulation is not about removing all discomfort. The [INACSL debriefing standard](https://doi.org/10.1016/j.ecns.2021.08.011) asks for privacy, open discussion and trust; [Kolbe et al.](https://doi.org/10.1136/bmjstel-2019-000470) describe restoring it. Co-design ## Who should write the scenario? The staff who do the work, with patients and families where possible: published scenarios are scarce, with 5 of 1,227 MedEdPORTAL records naming de-escalation or aggression in the title. Colleagues sort blank cards at a bench. ### A small published library [PubMed](https://pubmed.ncbi.nlm.nih.gov/?term=%22MedEdPORTAL%22%5Bta%5D) indexes 1,227 MedEdPORTAL records; 0.4% name de-escalation, escalation or aggression in the title, none workplace violence, so most organisations write their own. A facilitator leads a conversation at a table. ### Co-designed with staff and patients The [EDITION trial](https://doi.org/10.3310/fggw6874) co-designed training across 10 wards; in its uncontrolled evaluation, falls in conflict and containment were associated with study phase, and outcome completion was 68% overall and 76% after training. A wheelchair user and colleague rehearse. ### Staff rated it acceptable 211 of 214 trainees rated the co-delivered course: median 55 of 63 overall, 33 of 36 for acceptability, 23 of 27 for impact ([Grundy et al.](https://doi.org/10.1111/jpm.13074)). They valued lived-experience co-delivery most. An interpreter talks with an older resident. ### Patients and families can help [AHRQ](https://www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/resources/simulation-issue-brief.pdf) notes patients, families and community organisations can inform simulation design; a participatory [Danish trial](https://doi.org/10.1186/s12889-024-18527-5) reached 73% implementation. Guidance ## What do regulators and standards bodies expect? Practice and a debrief: OSHA writes that “Effective training programs should involve role-playing, simulations and drills”, and INACSL requires a planned debrief. A clinician rehearses a ward round. ### Written into standards and law [INACSL](https://doi.org/10.1016/j.ecns.2021.08.011): “All simulation-based educational (SBE) activities must include a planned debriefing process.” [California’s health care standard](https://www.dir.ca.gov/title8/3342.html) requires a practice debrief, and the [Joint Commission](https://www.jointcommission.org/-/media/tjc/documents/standards/r3-reports/wpvp-r3-30_revised_06302021.pdf) requires de-escalation training at hire and annually. Evidence ## Which studies does this rest on? The reviews, trials and datasets behind each figure. Sources, 2013 to 2025 Study Design Sample What was measured Result Tannenbaum and Cerasoli (2013), [Human Factors](https://doi.org/10.1177/0018720812448394) Meta-analysis 2,136 people Debrief against control d = 0.67 Keiser and Arthur (2021), [J Appl Psychol](https://doi.org/10.1037/apl0000821) Meta-analysis 61 studies After-action review d = 0.79 Keiser and Arthur (2022), [J Bus Psychol](https://doi.org/10.1007/s10869-021-09784-x) Meta-analysis 83 studies Moderators d = 0.92 Cheng et al. (2014), [Med Educ](https://doi.org/10.1111/medu.12432) Systematic review 11,511 learners Debrief features Video 0.10 Cook et al. (2013), [Med Teach](https://doi.org/10.3109/0142159X.2012.714886) Meta-analysis 18,971 trainees Design features Difficulty 0.68 Tong et al. (2022), [Nurse Educ Today](https://doi.org/10.1016/j.nedt.2022.105609) Meta-analysis 4,926 students Prebriefing 0.82 against 0.27 Grundy et al. (2024), [J Psychiatr Ment Health Nurs](https://doi.org/10.1111/jpm.13074) Survey 211 of 214 Acceptability Median 55 of 63 BLS (2025), [Table R8](https://www.bls.gov/iif/nonfatal-injuries-and-illnesses-tables/case-and-demographic-characteristics-table-r8-2023-2024.xlsx) Employer survey US private industry Injury rates 138.8 against 3.4 Decisions ## What does this mean for a buyer? Actions for the scenario brief. - Set the opening scenarios where violence concentrates. Psychiatric hospitals record 138.8 cases per 10,000; 38.04% of ambulance staff report physical violence. - Cast the other person as a patient, relative or visitor. Violence from the public ran 8.0 times the colleague rate in 2025. - Build difficulty levels and spaced repeats before realism. They pooled 0.68 and 0.66; fidelity differed by 1% to 2%. - Run a prebrief and a scripted debrief. Debrief effects run d = 0.67 to 0.92; a prebrief showed 0.82 against 0.27 on collaboration. - Write scenarios with staff and people with lived experience. 211 of 214 trainees rated a co-designed course, median 55 of 63. Board paper lines, ready to paste into a business case Across 46 samples, debriefed groups outperformed controls by about 25% (d = 0.67; Tannenbaum and Cerasoli, 2013), and later reviews report d = 0.79 and 0.92. Across 289 comparative simulation studies, range of difficulty (0.68) and distributed practice (0.66) showed the largest pooled skills effects, while fidelity differed by 1% to 2% (Cook et al., 2013; Norman et al., 2012). US psychiatric hospitals recorded 138.8 violent-act injury cases per 10,000 full-time workers in 2023-24 against 3.4 in ambulatory care (BLS Table R8), so our scenarios start in inpatient mental health and residential care. ## Limits and method What these figures cannot show, and how they were counted. - The pooled figures come from different outcomes and fields, including non-health teams. - Cook 2013 pooled studies with large heterogeneity (I2 over 50%); mastery learning rests on 3 studies, repetitive practice on 7. - Most trials measure performance inside a simulation, not at work. - No measured comparison of branching against linear scenarios was found. - The ratio sources (a 2010 chapter, a paywalled 2010 article) and the 2025 INACSL debriefing text were not read; the 2021 wording is quoted. - BLS rates are US private industry, 2023-24 annualised, OIICS version 3, not continuous with 2018. - NHS figures are self-report, for England, with corrected 2023 data; staff group values are 100 minus the share answering never. - The MedEdPORTAL title screen is PTR’s own; other libraries could not be read. EDITION results are uncontrolled associations. - Studies whose printed figures disagree internally are left out. - Every source was read on 26 September 2026. ## Where PTR fits PTR builds de-escalation practice in a headset, on screen and with AI characters, with scenarios written alongside staff. See [de-escalation training](https://peopletechrevolution.com/training/de-escalation), [VR de-escalation training](https://peopletechrevolution.com/training/vr-de-escalation-training), [training for healthcare](https://peopletechrevolution.com/training/de-escalation-training-healthcare), [AI roleplay practice](https://peopletechrevolution.com/ai/ai-roleplay-practice), [clinical educators](https://peopletechrevolution.com/training/for-clinical-educators-and-simulation-leads) and [how a pilot runs](https://peopletechrevolution.com/training/how-a-pilot-runs). - [Evaluating a de-escalation pilot](https://peopletechrevolution.com/insights/evaluate-de-escalation-training-pilot) - [What VR de-escalation research measured](https://peopletechrevolution.com/insights/vr-de-escalation-training-evidence) - [Branching scenarios and AI characters](https://peopletechrevolution.com/learn/xr/branching-scenarios-and-ai-characters) - [Workplace violence claims data](https://peopletechrevolution.com/insights/workplace-violence-claims-data) ## Cite this research Free to quote and cite with a link to this page. Name the version you read, so readers can see what has changed since. APA 7 Loza, K. (2026, September 27). The debrief carries the effect: what the evidence says about scenario and debrief design (Version 2.0). People Tech Revolution. https://peopletechrevolution.com/insights/design-de-escalation-scenario-debrief Copy citation Data: Meta-analyses and reviews of debriefing, simulation design, prebriefing, psychological safety and co-design (2006 to 2026); BLS Survey of Occupational Injuries and Illnesses, Table R8, 2023-24; NHS Staff Survey 2025 briefing and detailed spreadsheets; INACSL, AHRQ and OSHA guidance; PubMed counts of MedEdPORTAL records. Read 26 September 2026. ### Version history Version Date What changed Version 2.0 27 September 2026 Rebuilt on meta-analyses and national data: debrief and design effect sizes, BLS setting rates, NHS Staff Survey series, prebrief, co-design and guidance; 6 charts, evidence table, decisions and limits. Version 1.0 25 September 2026 First published. ## Sources Each study, dataset and standard at its publisher. ### [Tannenbaum and Cerasoli (2013). “Do team and individual debriefs enhance performance? A meta-analysis”. Human Factors](https://doi.org/10.1177/0018720812448394) Meta-analysis Debrief against control. ### [Keiser and Arthur (2021). “A meta-analysis of the effectiveness of the after-action review (or debrief) and factors that influence its effectiveness”. Journal of Applied Psychology](https://doi.org/10.1037/apl0000821) Meta-analysis After-action reviews. ### [Keiser and Arthur (2022). “The effectiveness of the after-action review approach: a meta-analytic review of moderator effects”. Journal of Business and Psychology](https://doi.org/10.1007/s10869-021-09784-x) Meta-analysis Where a debrief does most. ### [Cheng et al. (2014). “Debriefing for technology-enhanced simulation: a systematic review and meta-analysis”. Medical Education](https://doi.org/10.1111/medu.12432) Systematic review Video, length and structure. ### [Cook et al. (2013). “Comparative effectiveness of instructional design features in simulation-based education: systematic review and meta-analysis”. Medical Teacher](https://doi.org/10.3109/0142159X.2012.714886) Meta-analysis Design features compared. ### [Norman, Dore and Grierson (2012). “The minimal relationship between simulation fidelity and transfer of learning”. Medical Education](https://doi.org/10.1111/j.1365-2923.2012.04243.x) Review High against low fidelity. ### [Zhang et al. (2019). “Effectiveness of video-assisted debriefing in simulation-based health professions education: a systematic review of quantitative evidence”. Nurse Educator](https://doi.org/10.1097/NNE.0000000000000562) Systematic review Debrief time and video. ### [Fanning and Gaba (2007). “The role of debriefing in simulation-based learning”. Simulation in Healthcare](https://doi.org/10.1097/SIH.0b013e3180315539) Review, read in full No length ratio stated. ### [Tong et al. (2022). “Prebriefing for high-fidelity simulation in nursing education: a meta-analysis”. Nurse Education Today](https://doi.org/10.1016/j.nedt.2022.105609) Meta-analysis Prebriefing outcomes. ### [INACSL Standards Committee (2021). “Healthcare Simulation Standards of Best Practice: The Debriefing Process”. Clinical Simulation in Nursing](https://doi.org/10.1016/j.ecns.2021.08.011) Simulation standard A planned debrief. ### [INACSL Standards Committee (2021). “Healthcare Simulation Standards of Best Practice: Prebriefing: Preparation and Briefing”. Clinical Simulation in Nursing](https://doi.org/10.1016/j.ecns.2021.08.008) Simulation standard, revised 2025 What a prebrief covers. ### [Agency for Healthcare Research and Quality (2023). “TeamSTEPPS Pocket Guide”. AHRQ Publication 23-0043](https://www.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/teamstepps-pocket-guide.pdf) Pocket guide The debrief checklist. ### [Deutsch and Bajaj (2024). “Simulation To Improve Patient Safety: Getting Started”. AHRQ Publication 24-0055](https://www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/resources/simulation-issue-brief.pdf) Issue brief Who can inform design. ### [Occupational Safety and Health Administration (2016). “Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers”. OSHA 3148-06R](https://www.osha.gov/Publications/osha3148.pdf) Guidelines Role-play, drills, refreshers. ### [Bureau of Labor Statistics (2025). “Table R8: incidence rates by industry and event, private industry, 2023-2024”. Survey of Occupational Injuries and Illnesses](https://www.bls.gov/iif/nonfatal-injuries-and-illnesses-tables/case-and-demographic-characteristics-table-r8-2023-2024.xlsx) National dataset Rates by setting. ### [NHS Staff Survey (2026). “National Results Briefing 2025”. NHS England](https://www.nhsstaffsurveys.com/static/98fbf017ea18aad1523254e02072cd02/National-Results-Briefing-2025.pdf) National survey Violence by source. ### [Geoffrion et al. (2020). “Education and training for preventing and minimizing workplace aggression directed toward healthcare workers”. Cochrane Database of Systematic Reviews](https://doi.org/10.1002/14651858.CD011860.pub2) Systematic review Knowledge, skills, aggression. ### [Price et al. (2024). “Development and evaluation of a de-escalation training intervention in adult acute and forensic units: the EDITION systematic review and feasibility trial”. Health Technology Assessment](https://doi.org/10.3310/fggw6874) Feasibility trial Co-designed training. ### [Grundy et al. (2024). “Evaluation of a novel co-designed and co-delivered training package to de-escalate violence and aggression in UK acute inpatient, PICU and forensic mental health settings”. Journal of Psychiatric and Mental Health Nursing](https://doi.org/10.1111/jpm.13074) Acceptability study Staff ratings.