Effects of Peer-led Debriefing on Cognitive Load, Achievement Emotions, and Nursing Performance

Fluctuating cohesion: A grounded theory study of nursing students engaged in a combined debriefing format

AIM

This study explored the social processes enacted by nursing students when they engage in a combined format of structured peer debriefing followed by instructor-led debriefing after in-person simulation. The aim was to gain insight into nursing students' perceptions and how peer processes influenced reflection and learning.

BACKGROUND

Debriefing, a key component of clinical simulation, promotes development of nursing students' reflective processes and enhances learning. In-person group-debriefing led by faculty/instructors is the most used debriefing format in healthcare simulation education. Yet, recent studies indicate instructor-led formats may increase students' anxiety and limit their capacity for reflection, a crucial step in clinical reasoning and decision making. Investigations into learner-centered formats support peer debriefing as a reasonable alternative to traditional instructor-led debriefing. However, current peer debriefing studies provide little insight into the social interactions and processes supporting reflection and learning; and little theoretical basis exists for the integration of alternatives to instructor-led debriefing formats (such as peer debriefing) into simulation-based education.

DESIGN

This qualitative study used a Straussian grounded theory design.

METHODS

Senior-level baccalaureate and associate degree nursing students from an U.S. public university with first-hand experience using the combined format of peer debriefing followed by instructor-led debriefing were recruited to participate in focus-group interviews. Data gathered from semi structured interviews were analysed using the iterative process of constant comparison. Theory building was aided using memoing, theoretical sampling and conceptual diagramming.

RESULTS

The sample consisted of 34 students. Study findings revealed the core category of the constructed theory, 'Fluctuating cohesion', involved students' pervasive sense of going back and forth between a sense of unity (we-ness) and separatism (me-ness) while engaged in the combined debriefing format. The theory integrated five related categories: discovering the process, normalizing experiences, developing mutuality, dynamic balancing and engaging informal social connections. Findings illustrated the processes students enacted to take ownership for learning and proactively discuss their clinical decision-making with the instructor. In turn, reflection was enhanced by increased receptiveness to subsequent expert feedback.

CONCLUSIONS

The study findings demonstrated that augmenting instructor-led debriefing with peer debriefing leveraged the beneficial nature of peer interactions, promoted psychological safety, facilitated nascent team behaviors and enhanced reflective thinking. The resultant theory that was generated from the findings and grounded in participants' experience, provides a meaningful framework that may inform future learner-centered debriefing formats aimed at optimizing debriefing effectiveness.

Exploring in-person self-led debriefings for groups of learners in simulation-based education: an integrative review

BACKGROUND

Facilitator-led debriefings are well-established for debriefing groups of learners in immersive simulation-based education. However, there has been emerging interest in self-led debriefings whereby individuals or groups of learners conduct a debriefing themselves, without the presence of a facilitator. How and why self-led debriefings influence debriefing outcomes remains undetermined.

RESEARCH AIM

The aim of this study was to explore how and why in-person self-led debriefings influence debriefing outcomes for groups of learners in immersive simulation-based education.

METHODS

An integrative review was conducted, searching seven electronic databases (PubMed, Cochrane, Embase, ERIC, SCOPUS, CINAHL Plus, PsychINFO) for peer-reviewed empirical studies investigating in-person self-led debriefings for groups of learners. Data were extracted, synthesised, and underwent reflexive thematic analysis.

RESULTS

Eighteen empirical studies identified through the search strategy were included in this review. There was significant heterogeneity in respect to study designs, aims, contexts, debriefing formats, learner characteristics, and data collection instruments. The synthesised findings of this review suggest that, across a range of debriefing outcome measures, in-person self-led debriefings for groups of learners following immersive simulation-based education are preferable to conducting no debriefing at all. In certain cultural and professional contexts, such as postgraduate learners and those with previous debriefing experience, self-led debriefings can support effective learning and may provide equivalent educational outcomes to facilitator-led debriefings or self-led and facilitator-led combination strategies. Furthermore, there is some evidence to suggest that self-led and facilitator-led combination approaches may optimise participant learning, with this approach warranting further research. Reflexive thematic analysis of the data revealed four themes, promoting self-reflective practice, experience and background of learners, challenges of conducting self-led debriefings and facilitation and leadership. Similar to facilitator-led debriefings, promoting self-reflective practice within groups of learners is fundamental to how and why self-led debriefings influence debriefing outcomes.

CONCLUSIONS

In circumstances where simulation resources for facilitator-led debriefings are limited, self-led debriefings can provide an alternative opportunity to safeguard effective learning. However, their true value within the scope of immersive simulation-based education may lie as an adjunctive method alongside facilitator-led debriefings. Further research is needed to explore how to best enable the process of reflective practice within self-led debriefings to understand how, and in which contexts, self-led debriefings are best employed and thus maximise their potential use.

Exploring the ethics of physical restraints: Students' questioning

BACKGROUND

Physical restraints are routinely employed to ensure patient safety in Japanese acute care. Little is known about nursing students' perspectives and how they begin to question their value and knowledge in the face of restraint experiences in clinical practice.

OBJECTIVE

To investigate nursing students' questions about patient restraints and how they understand the ethics of the use of restraints in nursing.

RESEARCH DESIGN

Qualitative descriptive research using narrative analysis.

PARTICIPANTS AND RESEARCH CONTEXT

Experiential data were generated and thematically analyzed from semi-structured interviews with 16 nursing students who had completed their bachelor's degree program requirements.

ETHICAL CONSIDERATIONS

The study was approved by academic and clinical ethics agencies. Participants provided written informed consent.

RESULTS

Physical restraints were encountered in 16 incidents, 3 with children and 13 with older patients with dementia. Students struggled to comprehend the policies and protocols of restraint use and worried their use was primarily for security rather than therapeutic purposes. Five themes were identified: (1). Questioning the tension between person-centered care, patient autonomy, and restraints, (2). Questioning the nature of restraints in which participants analyzed the policies and protocols around restraint use, (3). Questioning the professional nursing self whereby students reflected on how restraint use challenged their nursing values, and (4). Questioning professional nursing practice, in which students explored how restraints fit within a nursing perspective and positioned themselves as patient advocates. Students encountering physical restraints should ask questions based on values of patient-centeredness, autonomy, and advocacy. There is a need for education that facilitates reflection and questioning so that it informs students' ethical thinking which may enhance nurse advocacy to reduce restraint use.

CONCLUSIONS

Restraints provide contexts in which students must face tensions between nursing values and clinical reality. Further research on nursing education strategies within non-psychiatric settings is needed to reduce physical restraints.

Gender Differences in Psychological Safety, Academic Safety, Cognitive Load, and Debriefing Satisfaction in Simulation-Based Learning

BACKGROUND

As there is an increasing trend in the number of male-identifying learners in undergraduate nursing education, a need exists to identify the gender differences in learners' perceptions regarding simulation-based learning.

PURPOSE

This study aimed to identify the gender differences in psychological safety, academic safety, cognitive load, and debriefing satisfaction in simulation-based nursing education.

METHODS

A cross-sectional descriptive survey was implemented with 97 female and 95 male nursing students. Data were analyzed using Mann-Whitney U tests or independent-samples t tests.

RESULTS

Female nursing students reported a lower academic safety and higher intrinsic load than male nursing students. Male nursing students perceived a higher germane load than female nursing students.

CONCLUSIONS

The significance of the present study was the identification of gender differences in participant perception of the simulation learning experience for effective simulation design.

Influencing factors of learning sustained attention for nursing students in online settings: A structural equation model

BACKGROUND

Sustained attention is a key variable affecting nursing students' academic performance during online learning process. However, factors contributing to sustained attention remain to be determined.

AIMS

To analyze the path relationships among the influencing factors for nursing students' sustained attention in online learning using a structural equation model.

DESIGN

A cross-sectional survey was administered.

METHODS

Nursing students from 35 nursing schools in China were invited to participate in this survey study. Once participating in nursing programs and receiving online learning, they were eligible for the study. The data were collected online via the Questionnaire Star platform from March 29 to April 19, 2020. A structural equation modelling (SEM) approach was utilized to analyze the relationships between sustained attention and influencing factors (situational interest, anxiety, cognitive load, technology efficacy and professional identity). Furthermore, multi-group SEM analysis was conducted to examine whether the model equally fitted nursing students in different levels of programs.

RESULTS

A total of 1089 nursing students completed the questionnaires. The majority (77.3%) were female and the mean age (SD) was 21.9 (4.4) years. A half (50.3%) were enrolled in the undergraduate programs. Results suggested that situational interest (β = 0.19, 95% CI: 0.14, 0.24) and anxiety (β = -0.70, 95% CI: -0.76, -0.64) directly affected sustained attention. Both technology efficacy (β = 0.22, 95% CI: 0.15, 0.28) and professional identity (β = 0.20, 95% CI: 0.14, 0.26) had conferred indirect effects on sustained attention through academic emotions (i.e., situational interest and anxiety). The cognitive load directly affected sustained attention (β = -0.15, 95% CI: -0.20, -0.09) and indirectly affected sustained attention through anxiety (β = -0.32, 95% CI: -0.37, -0.26). There was no significant difference in the model fit among nursing students in various programs, including diplomatic, associate and bachelor's degree and above programs (∆χ2 = 27.228, p = 0.611).

CONCLUSIONS

Technology efficacy, professional identity, situational interest, anxiety and cognitive load are identified as the main elements affecting nursing students' sustained attention. This model is equally suitable for nursing students in different levels of nursing programs. During the process of online learning, students' attributes, emotions and cognition should be considered to help students achieve learning goals in nursing education.

Application of the cognitive load theory in prelicensure nursing education: a quantitative measurement focusing on instructional design

The objective of this study was to examine differences in principles from the cognitive load theory (CLT) combined with active learning strategies. To examine these differences, simple to complex activities were imbedded into two active learning instructional strategies: cooperative learning (CPL) and problem-based learning (PBL) and evaluated for its impact on mental effort for learning and intrinsic cognitive load. A two-within repeated-measures design was used in a nursing fundamentals classroom. The simple and complex activities were grounded in recommendations from the CLT and validated by nurse experts. The instructional strategies of CPL and PBL were chosen based on recommendations from the literature. Results revealed no statistically significant differences. A small interaction showed a decrease in mental effort and intrinsic load when problem-based learning was used. Progressing learning activities from simple to complex, informed by the CLT, offers an approach to designing instruction in nursing classrooms when using active learning strategies.