Student preferences and perceptions of learning from vSIM for Nursing™

This study explored BSN students' perceptions of learning with vSim for Nursing™. Using a mixed methods design with 99 students, key points of learning were medication administration and respiratory interventions. Qualitative data demonstrated learning of assessment, prioritization, and emergency management. The top student preferences of how to use virtual simulation were as a clinical makeup or to enhance lecture. The findings support the use of virtual simulation and provide data to guide nurse educators to more strategically integrate virtual simulation exercises.

Frameworks and quality measures used for debriefing in team-based simulation: a systematic review

Objectives

The skill of the debriefer is known to be the strongest independent predictor of the quality of simulation encounters yet educators feel underprepared for this role. The aim of this review was to identify frameworks used for debriefing team-based simulations and measures used to assess debriefing quality.

Methods

We systematically searched PubMed, CINAHL, MedLine and Embase databases for simulation studies that evaluated a debriefing framework. Two reviewers evaluated study quality and retrieved information regarding study methods, debriefing framework, outcome measures and debriefing quality.

Results

A total of 676 papers published between January 2003 and December 2017 were identified using the search protocol. Following screening of abstracts, 37 full-text articles were assessed for eligibility, 26 studies met inclusion criteria for quality appraisal and 18 achieved a sufficiently high-quality score for inclusion in the evidence synthesis. A debriefing framework was used in all studies, mostly tailored to the study. Impact of the debrief was measured using satisfaction surveys (n=11) and/or participant performance (n=18). Three themes emerged from the data synthesis: selection and training of facilitators, debrief model and debrief assessment. There was little commonality across studies in terms of participants, experience of faculty and measures used.

Conclusions

A range of debriefing frameworks were used in these studies. Some key aspects of debrief for team-based simulation, such as facilitator training, the inclusion of a reaction phase and the impact of learner characteristics on debrief outcomes, have no or limited evidence and provide opportunities for future research particularly with interprofessional groups.

Analysis of midwifery teachers' approach to identifying student midwives with poor clinical reasoning skills

OBJECTIVE

To analyse midwifery teachers' pedagogic approaches to remediation for student midwives with poor clinical reasoning skills.

METHODS

A mixed-methods approach using a questionnaire and in-depth interviews.

SETTING

Midwifery schools in France.

PARTICIPANTS

Teachers in French midwifery schools.

MEASUREMENTS AND FINDINGS

A quarter of the teachers had no training in clinical reasoning. Midwifery teachers mainly identified students' clinical reasoning difficulties during clinical supervision with a non-validated tool. All teachers detected the warning signs and the main obstacles identifying student midwives with poor clinical reasoning skills along with some identifying factors favouring those difficulties. However, the remedial strategies proposed were mainly reassessment without personalised corrective learning activities.

KEY CONCLUSIONS

The approach to identifying student midwives with poor clinical reasoning skills was incomplete and remedial strategies were stereotypical.

IMPLICATIONS FOR PRACTICE

Midwifery teachers should be trained to recognise their students' clinical reasoning issues to identify them early, using all types of learning activities. Remedial strategies should be implemented promptly, adapted to each student and foster the transfer of learning.

Coaching the Debriefer: Peer Coaching to Improve Debriefing Quality in Simulation Programs

STATEMENT

Formal faculty development programs for simulation educators are costly and time-consuming. Peer coaching integrated into the teaching flow can enhance an educator's debriefing skills. We provide a practical guide for the who, what, when, where, why, and how of peer coaching for debriefing in simulation-based education. Peer coaching offers advantages such as psychological safety and team building, and it can benefit both the educator who is receiving feedback and the coach who is providing it. A feedback form for effective peer coaching includes the following: (1) psychological safety, (2) framework, (3) method/strategy, (4) content, (5) learner centeredness, (6) co-facilitation, (7) time management, (8) difficult situations, (9) debriefing adjuncts, and (10) individual style and experience. Institutional backing of peer coaching programs can facilitate implementation and sustainability. Program leaders should communicate the need and benefits, establish program goals, and provide assessment tools, training, structure, and evaluation to optimize chances of success.

Implementing a Theoretical Debriefing Model in a Prelicensure BSN Program

The National League for Nursing and International Nursing Association for Clinical Simulation and Learning stress that debriefing fosters critical reflection and is essential to all educational settings. The call to action for nurse educators is to incorporate theory-based debriefing throughout the curriculum. This article reports on how one school of nursing implemented the theory-based model, Debriefing for Meaningful Learning©, into the prelicensure baccalaureate curriculum.

Relaxation before Debriefing during High-fidelity Simulation Improves Memory Retention of Residents at Three Months

Background

High-fidelity simulation is known to improve participant learning and behavioral performance. Simulation scenarios generate stress that affects memory retention and may impact future performance. The authors hypothesized that more participants would recall three or more critical key messages at three months when a relaxation break was performed before debriefing of critical event scenarios.

Methods

Each resident actively participated in one scenario and observed another. Residents were randomized in two parallel-arms. The intervention was a 5-min standardized relaxation break immediately before debriefing; controls had no break before debriefing. Five scenario-specific messages were read aloud by instructors during debriefings. Residents were asked by telephone three months later to recall the five messages from their two scenarios, and were scored for each scenario by blinded investigators. The primary endpoint was the number of residents participating actively who recalled three or more messages. Secondary endpoints included: number of residents observing who recalled three or more messages, anxiety level, and debriefing quality.

Results

In total, 149 residents were randomized and included. There were 52 of 73 (71%) residents participating actively who recalled three or more messages at three months in the intervention group versus 35 of 76 (46%) among controls (difference: 25% [95% CI, 10 to 40%], P = 0.004). No significant difference was found between groups for observers, anxiety or debriefing quality.

Conclusions

There was an additional 25% of active participants who recalled the critical messages at three months when a relaxation break was performed before debriefing of scenarios. Benefits of relaxation to enhance learning should be considered for medical education.

Effects of a work-based critical reflection program for novice nurses

BACKGROUND

Critical reflection is effective in improving students' communication abilities and confidence. The aim of this study was to evaluate the effectiveness of a work-based critical reflection program to enhance novice nurses' clinical critical-thinking abilities, communication competency, and job performance.

METHODS

The present study used a quasi-experimental design. From October 2014 to August 2015, we collected data from 44 novice nurses working in an advanced general hospital in S city in Korea. Nurses in the experimental group participated in a critical reflection program for six months. Outcome variables were clinical critical-thinking skills, communication abilities, and job performance. A non-parametric Mann-Whitney U-test and a Wilcoxon rank sum test were selected to evaluate differences in mean ranks and to assess the null hypothesis that the medians were equal across the groups.

RESULTS

The results showed that the clinical critical-thinking skills of those in the experimental group improved significantly (p = 0.003). The differences in mean ranks of communication ability between two groups was significantly statistically different (p = 0.028). Job performance improved significantly in both the experimental group and the control group, so there was no statistical difference (p = 0.294).

CONCLUSIONS

We therefore suggest that a critical reflection program be considered an essential tool for improving critical thinking and communication abilities among novice nurses who need to adapt to the clinical environment as quickly as possible. Further, we suggest conducting research into critical reflection programs among larger and more diverse samples.

Reflection in the training of nurses in clinical practice settings: a scoping review protocol

This scoping review will seek to find answers for the following questions which will focus on the use of reflection in the education of nurses in clinical settings:The review will also extract and map data regarding: i) what outcomes have been found in relation to the use of different tools and approaches (e.g. dialogues, diaries, case studies); ii) how approaches and tools have been implemented as interventions; iii) details of the topic or focus of reflection (e.g. ethical issues, care of older adults etc.); iv) details about the participants involved in reflection activities (e.g. first or second year undergraduate nursing students etc.); and v) barriers/challenges to the use of reflection approaches/tools. Additional details may also be extracted and mapped during the process of the scoping review and this will be explained in the final scoping review report.

Survey of factors influencing learner engagement with simulation debriefing among nursing students

Simulation-based education has escalated worldwide, yet few studies have rigorously explored predictors of learner engagement with simulation debriefing. The purpose of this cross-sectional, descriptive survey was to identify factors that determine learner engagement with simulation debriefing among nursing students. A convenience sample of 296 Korean nursing students enrolled in the simulation-based course completed the survey. A total of five instruments were used: (i) Characteristics of Debriefing; (ii) Debriefing Assessment for Simulation in Healthcare - Student Version; (iii) The Korean version of the Simulation Design Scale; (iv) Communication Skills Scale; and (v) Clinical-Based Stress Scale. Multiple regression analysis was performed using the variables to investigate the influencing factors. The results indicated that influencing factors of learning engagement with simulation debriefing were simulation design, confidentiality, stress, and number of students. Simulation design was the most important factor. Video-assisted debriefing was not a significant factor affecting learner engagement. Educators should organize and conduct debriefing activities while considering these factors to effectively induce learner engagement. Further study is needed to identify the effects of debriefing sessions targeting learners' needs and considering situational factors on learning outcomes.

Clinical Judgment Scripts as a Strategy to Foster Clinical Judgments

BACKGROUND

Clinical judgment encompasses how nurses use their knowledge of the patient to generate, assess, and prioritize patient care alternatives. Previous research has identified debriefing as critical to developing clinical judgment. Best practice for debriefing has yet to be identified. The purpose of this research was to investigate whether a standard debriefing script, based on Tanner's clinical judgment model, could foster clinical judgment.

METHOD

Participants were senior nursing students in their final semester of study. Data were gathered and analyzed from three sources: independent raters observing students in simulation, participating students, and the students' clinical instructors.

RESULTS

Students identified the script as an effective debriefing tool, and significant improvements were observed in clinical judgment scores from all data sources.

CONCLUSION

The standardized debriefing script helped students focus on the learning process, resulting in student improvement in all areas of clinical judgment: noticing, interpreting, responding, and reflecting. [J Nurs Educ. 2016;55(12):691-695.].

Using Simulation and Case Studies Combined to Improve Student Knowledge: A Retrospective Study

AIM

The aim of the study was to examine effects of high-fidelity simulation and computerized case studies in an advanced medical-surgical course.

BACKGROUND

The challenges of coordinating clinical education and desire to utilize innovative methods of teaching were the impetus for course design.

METHOD

A retrospective review compared HESITM specialty exam scores for groups of the newer and former course design. In the newly configured course, students alternated weekly between simulation and computer-assisted case studies and traditional clinical experiences.

RESULTS

Quantitative methods were utilized to analyze data; HESI specialty exam scores were determined to be statistically significantly higher for the groups of the newer design model.

CONCLUSION

Incorporating case studies and high-fidelity simulation on a biweekly basis may be the reason for improved performance.

The Impact of Simulation Prebriefing on Perceptions of Overall Effectiveness, Learning, and Self-Confidence in Nursing Students

AIM

The aim of this study was to evaluate the impact of simulation prebriefing on nursing students' perceptions of overall effectiveness, learning, and self-confidence.

BACKGROUND

Most research highlights debriefing as the most important component influencing learning outcomes; the focus on prebriefing is limited.

METHOD

This quasiexperimental design study compared outcomes among four groups of undergraduate students (n = 119) at two schools of nursing: no prebriefing, prebriefing with learning engagement and orientation activities, prebriefing with orientation activities, and prebriefing with learning engagement activities.

RESULTS

Perceptions of overall simulation effectiveness, learning, and self-confidence were significantly higher with prebriefing (p = .000) compared to no prebriefing. No significant distinction (p >.05) was found among the prebriefing activities.

CONCLUSION

Findings from this study support the use of learning engagement and orientation activities during prebriefing in order to enhance overall simulation effectiveness.

A Review of Debriefing Practices

Abstract. There appears to be a wide acceptance that debriefing plays an important role in the learning process of simulation-based programs. Indeed, the past decade has witnessed an increasing number of studies into debriefing across disciplines. Our research team has been conducting field research with airlines, over a number of years, to clarify what constitutes effective debriefing for airline pilot training. To assist this clarification, a comprehensive systematic review of existing studies into debriefing across disciplines was designed to direct further analysis of the data the team had collected. A preliminary investigation into this broad debriefing literature exposed that there was little consensus among many papers about effective debriefing practice owing to inconsistencies in: (a) methodological approaches, (b) terminology, and (c) professional focus. As a way of overcoming these inconsistencies, this paper initially synthesized research findings from a small number of existing systematic reviews scrutinizing debriefing across a variety of professional disciplines. The literature search identified 10 papers, three meta-analyses, and seven qualitative systematic reviews. This paper aims to identify key elements influencing learning outcomes from debriefing practices and presents the findings of this study as a single framework of debriefing elements.

Debriefing in Laboratory Experiences: A Quality Improvement Project

The purpose of this project was to explore (a) how nursing students regarded debriefing sessions at the end of a laboratory skills class and (b) the cognitive, affective, and social learning outcomes of debriefing sessions. Survey questionnaires were administered to 378 prelicensure nursing students after their nursing skills laboratory class that included a debriefing session. Most students either agreed or strongly agreed that debriefing facilitated the discussion about their experience and reflection on learning.

Contribution of a reflective debriefing to nursing students' clinical judgment in patient deterioration simulations: A mixed-methods study

BACKGROUND

While reflection is a hallmark of debriefing, there is little understanding of how it contributes to nursing students' clinical judgment.

OBJECTIVES

The aim of this study was to describe how nursing students perceived that the Reflective dEbriefing after a PatieNt Deterioration simulation (REsPoND) fostered learning and how it contributed to their clinical judgment in patient deterioration simulations.

DESIGN

A sequential explanatory mixed-methods study.

PARTICIPANTS

Nineteen students who showed the greatest clinical judgment score variation in a randomized controlled trial of the effectiveness of REsPoND.

METHODS

Students participated in interviews on their learning experience in REsPoND. Data were subjected to thematic analysis and themes were contrasted according to students' score variations.

RESULTS

Through guided exchanges with their peers, students configured a causes-observations-interventions framework that embodied their understanding of the patient's situation. They evaluated their own simulation performance based on that framework. The contribution of REsPoND to students' clinical judgment differed depending on (1) the value placed on the review of the simulation through a systematic assessment approach; (2) their focus on anticipating the situation or on performing in the simulation; and (3) their preference for who participated more in debriefing.

CONCLUSION

Clinical judgment might be improved when a systematic assessment approach is used to structure debriefing. The relationship between reflection and self-assessment during debriefing remains to be disentangled.

Developing an instrument to measure emotional behaviour abilities of meaningful learning through the Delphi technique

AIM

To identify items for a new instrument that measures emotional behaviour abilities of meaningful learning, according to Fink's Taxonomy.

BACKGROUND

Meaningful learning is an active process that promotes a wider and deeper understanding of concepts. It is the result of an interaction between new and previous knowledge and produces a long-term change of knowledge and skills. To measure meaningful learning capability, it is very important in the education of health professionals to identify problems or special learning needs. For this reason, it is necessary to create valid instruments.

DESIGN

A Delphi Study technique was implemented in four phases by means of e-mail.

METHODS

The study was conducted from April-September 2015. An expert panel consisting of ten researchers with experience in Fink's Taxonomy was established to identify the items of the instrument. Data were analysed for conceptual description and item characteristics and attributes were rated. Expert consensus was sought in each of these phases. An 87·5% consensus cut-off was established.

RESULTS

After four rounds, consensus was obtained for validation of the content of the instrument 'Assessment of Meaningful learning Behavioural and Emotional Abilities'. This instrument consists of 56 items evaluated on a 6-point Likert-type scale. Foundational Knowledge, Application, Integration, Human Dimension, Caring and Learning How to Learn were the six major categories explored.

CONCLUSIONS

This content validated tool can help educators (teachers, trainers and tutors) to identify and improve the strategies to support students' learning capability, which could increase their awareness of and/or responsibility in the learning process.

The practice of simulation-based assessment in respiratory therapy education

Clinical simulation has gained prominence as an educational approach in many Canadian respiratory therapy programs and is strongly associated with improved learning, clinical and nonclinical skill, future performance, and patient outcomes. Traditionally, the primary assessment approach employed in clinical simulation has been formative debriefing for learning. Contextual factors, such as limited opportunities for learning in clinical practice and technologically oriented perspectives on learning in clinical simulation, are converging to prompt a move from using formative debriefing sessions that support learning in simulation to employing high-stakes testing intended to measure entry-to-practice competencies. We adopt the perspective that these factors are intricately linked to the profession's regulatory environment, which may strongly influence how simulation practices become embedded with respiratory therapy educational programs. Through this discussion we challenge the profession to consider how environmental factors, including externally derived requirements, may ultimately impact the effectiveness of simulation-based learning environments.

Impact of prebriefing on competency performance, clinical judgment and experience in simulation: An experimental study

BACKGROUND

Prebriefing is the introductory phase of the simulation process, however, little nursing education research is available on this aspect of simulation. Reflection theory and concept mapping informed a model-based structured prebriefing activity to prepare students for meaningful simulation learning.

OBJECTIVES

The aim of this study was to examine the intervention of structured prebriefing for its effect on nursing students' competency performance, clinical judgment and their perceived prebriefing experience.

DESIGN

An experimental group-randomized design was used in this study; the intervention group who received structured prebriefing was compared to the control group.

SETTING

The study was conducted at a university school of nursing in Canada.

PARTICIPANTS

Baccalaureate nursing students (N=76) enrolled in a fourth-year medical-surgical course participated in this study.

METHOD

Competency performance, clinical judgment, and the perception of the prebriefing experience of those participants receiving structured prebriefing and those receiving traditional prebriefing activities, were compared. The relationship between simulation performance and students' self-rated prebriefing experience was also examined. Scores from the Creighton Competency Evaluation Instrument and the Prebriefing Experience Scale were analyzed using parametric and non-parametric statistics.

RESULTS

A statistically significant difference was demonstrated between groups for competency performance (p<0.001), clinical judgment (p<0.001) and prebriefing experience (p<0.001). No relationship was found between perception of prebriefing experience and students' simulation performance.

CONCLUSION

Theory-based, structured prebriefing can impact nursing student competency performance, clinical judgment and perceptions of prebriefing, and may enhance meaningful simulation learning.

Predictors of student performance on the Pharmacy Curriculum Outcomes Assessment at a new school of pharmacy using admissions and demographic data

OBJECTIVES

To characterize student performance on the Pharmacy Curriculum Outcomes Assessment (PCOA) and to determine the significance of specific admissions criteria and pharmacy school performance to predict student performance on the PCOA during the first through third professional years.

METHODS

Multivariate linear regression models were developed to study the relationships between various independent variables and students' PCOA total scores during the first through third professional years.

RESULTS

To date, four cohorts have successfully taken the PCOA examination. Results indicate that the Pharmacy College Admissions Test (PCAT), the Health Science Reasoning Test (HSRT), and cumulative pharmacy grade point average were the only consistent significant predictors of higher PCOA total scores across all students who have taken the exam at our school of pharmacy.

CONCLUSION

The school should examine and clarify the role of PCOA within its curricular assessment program. Results suggest that certain admissions criteria and performance in pharmacy school are associated with higher PCOA scores.

Simulation debriefing for clinical judgment development: A concept analysis

OBJECTIVE

The aim of this review was to provide an in-depth analysis of debriefing in nursing simulation-based learning. Specifically, the authors sought to describe the debriefing concept within the context of enhancing nursing students' clinical judgment skill.

DESIGN

Concept analysis.

DATA SOURCES

A literature review was conducted using five electronic databases with the addition of references for relevant papers reviewed. Medline Ovid, Cumulative Index to Nursing and Allied Health (CINAHL) Plus, Educational Resources Information Center (ERIC), ScienceDirect and Google Scholar were searched for articles published in English between 2005 and 2015. Search terms included clinical judgment, debriefing, and simulation.

REVIEW METHODS

The Walker and Avant systematic approach was utilized as a concept analysis framework. The analysis informed how the concept is defined in the existing literature.

RESULTS

The search resulted in a total of 47 articles. The concept of debriefing was analyzed using seven themes from Walker and Avant: concept definition, defining attributes, antecedents, consequences, empirical referents, uses of the concept, and a model case. Based on the analysis, an integrative simulation debriefing guide for promoting students' clinical judgment was presented as a vehicle for a consistent approach.

CONCLUSIONS

This review identified simulation debriefing as a structured and guided reflection process in which students actively appraise their cognitive, affective, and psychomotor performance within the context of their clinical judgment skill. Reflective debriefing provides students with an opportunity to assume an active role during the learning process. Following a structured debriefing guide can help educators and even students facilitate a learning environment that enhances students' clinical judgment development.

Mock Hospital Ethics Committee: An Innovative Simulation to Teach Prelicensure Nursing Students the Complexities of Ethics in Practice

Limited opportunities exist for prelicensure nursing students to observe the interprofessional process required to resolve complex ethical cases in practice. Therefore, a mock hospital ethics committee (MHEC) was assembled to teach the application of ethics in practice through simulation. The MHEC meeting is an example of how nursing education and practice can partner to create meaningful learning experiences.

Exploring Student and Faculty Perceptions of Clinical Simulation: A Q-Sort Study

BACKGROUND

Simulation learning has become a widely accepted and valuable methodology within nursing education. This study assessed whether student and faculty perceptions regarding simulation learning have changed since curricular integration of simulation activities within an undergraduate nursing program.

METHOD

Q-methodology was used to identify unique and similar perspectives of 12 faculty and 21 students. Participants completed a brief demographic questionnaire and sorted statements related to beliefs about simulation-based learning.

RESULTS

Faculty perceptions were captured within one viewpoint-positive enthusiasts. Three student viewpoints were identified: challenge seekers, realistic embracers, and support seekers. Both students and faculty believed that simulation improved critical thinking.

CONCLUSION

The findings suggest that faculty should be aware of the range of student perceptions and tailor their teaching approaches accordingly to maximize student learning.