Successful debriefing - best methods to achieve positive learning outcomes: a literature review

Development of a Midwifery Student Peer Debriefing Tool: An interpretive descriptive study

BACKGROUND

Psychosocial traumatisation associated with giving birth, can occur in those present with the woman giving birth, a phenomenon known as vicarious trauma. It has been identified that there are currently no interventions available for midwifery students who have experienced vicarious trauma following difficult birth experiences.

OBJECTIVE

To explore whether the counselling intervention developed by Gamble et al. (2005), can be adapted for midwifery students to be appropriately and feasibly used as a counselling intervention with peers who have experienced midwifery practice-related vicarious trauma.

DESIGN

Interpretive descriptive methodology.

SETTING

This study was set at two Australian universities from which pre-registration midwifery courses are delivered.

PARTICIPANTS

The work of reviewing the original tool and adapting it for use by and with midwifery students associated with this project was conducted by a key stakeholder group of seven representative midwifery students and five midwifery academics.

METHODS

Ethics were approved. Data were collected via one face to face and two online conversations using the Microsoft Teams™ platform. Reflexive Thematic analysis were applied to revise the tool following each round of data collection and to finalise the adaptation of the intervention for its new intended purpose.

RESULTS

The Midwifery Student Peer Debriefing Tool is presented as a six-step intervention that guides the midwifery student through a process of debriefing with their peer. The feasibility of the tool resulted in an overarching theme labelled "I want this to mean something" and captures the therapeutic power of peer debriefing toward a meaningful outcome that fostered growth, and a deeper understanding of the profession.

CONCLUSION

Vicarious trauma is widely recognised as a core reason for midwives and midwifery students leaving the workforce. The peer debriefing tool helps midwifery students move through the process of recovering from adversity but also fostered learnings about midwifery practice and the profession.

Strengthening critical thinking through debriefing - experiential learning theory: A case study

BACKGROUND

There is a dire need to strengthen students' critical thinking in clinical training since it is an essential skill in clinical practice to optimize patient care. Debriefing is a formal or informal post-activity discussion that aims to improve learning outcomes, including critical thinking in clinical practice. There is a lack of research that focuses on students' experiences of debriefing to promote critical thinking in the South African context using experiential learning theory as a theoretical lens.

OBJECTIVE

This study aimed to explore South African students' lived experiences of debriefing to improve critical thinking.

MATERIALS AND METHOD

The author employed a qualitative single-case study design within an interpretivist paradigm. A purposive sampling technique was adopted. Six participants were recruited for this study. The author invited the participants to participate in semi-structured interviews. Data were analyzed through the six-step data analysis framework proposed by Creswell. To ensure the trustworthiness, the author employed multiple techniques to improve the credibility, conformability, dependability, and transferability of this study. These techniques included a well-planned research design and methods, thick descriptions of data, and an audit trail that was audited by a second coder.

RESULTS

The findings revealed that participants shared positive experiences toward debriefing and furthermore debriefing through optimized student engagement and improved learning outcomes. This study also revealed that students experienced less stress in group debriefings. However, this study also identified some challenges in conducting debriefing. The challenges were primarily related to incompetent facilitators, inappropriate duration of debriefing sessions, and limited space in the clinic. Moreover, small group debriefing is recommended.

CONCLUSION

Debriefing is an effective pedagogical approach to optimize critical thinking in clinical practice. It is recommended that debriefing should be implemented as a norm in clinical training at higher education institutions. Further studies are recommended to be conducted at national and international levels.

Practical tips to improve bedside teaching using learning theories and clinical reasoning

Bedside teaching strengthens the link between theory and practice. The tips given here, which were derived from various learning theories and models, aim to provide structure to bedside teaching and to make this format effective, even though empirical evidence is still missing for this specific setting. These 10 tips may not always be fully implemented in each bedside teaching, but they should be applied selectively for targeted students. In essence, they are more to be understood as a repertoire of effective methods and are intended to expand the literature and framework concepts already available.

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.

Automated Video Debriefing Using Computer Vision Techniques

INTRODUCTION

Within any training event, debriefing is a vital component that highlights areas of proficiency and deficiency, enables reflection, and ultimately provides opportunity for remediation. Video-based debriefing is desirable to capture performance and replay events, but the reality is rife with challenges, principally lengthy video and occlusions that block line of sight from camera equipment to participants.

METHODS

To address this issue, researchers automated the editing of a video debrief, using a system of person-worn cameras and computer vision techniques. The cameras record a simulation event, and the video is processed using computer vision. Researchers investigated a variety of computer vision techniques, ultimately focusing on the scale invariant feature transform detection method and a convolutional neural network. The system was trained to detect and tag medically relevant segments of video and assess a single exemplar medical intervention, in this case the application of a tourniquet.

RESULTS

The system tagged medically relevant video segments with 92% recall and 66% precision, resulting in an F1 (harmonic mean of precision and recall) of 72% (N = 23). The exemplar medical intervention was successfully assessed in 39.5% of videos (N = 39).

CONCLUSION

The system showed suitable accuracy tagging medically relevant video segments, but requires additional research to improve medical intervention assessment accuracy. Computer vision has the potential to automate video debrief creation to augment existing debriefing strategies.

The Spiritual Supporter Scale as a New Tool for Assessing Spiritual Care Competencies in Professionals: Design, Validation, and Psychometric Evaluation

This study aimed to design, validate and standardize the Spiritual Supporter (SpSup) Scale, a tool designed to assess competency to provide spiritual care including knowledge, sensitivity to spiritual needs and spiritual support skills. This instrument can be used by all those engaged in or training for caregiving roles. The study was conducted in Poland in the Polish language. The SpSup Scale demonstrates high overall reliability (Cronbach's α = 0.88), a satisfactory diagnostic accuracy (0.79), and a satisfactory discriminatory power of the items. Given the psychometric properties of SpSup Scale demonstrated here, the scale is recommended for the assessment of the competency to provide spiritual care in both clinical and research settings in Poland.

Impact of simulation debriefing structure on knowledge and skill acquisition for postgraduate critical care nursing students: three-phase vs. multiphase

BACKGROUND

Simulation is part of the training provided to nurses enrolled in the master's degree for critical care nursing programmes at our institution. Although the students are practicing nurses, many still make mistakes when performing nursing procedures related to critical care during simulation sessions, and these mistakes must be addressed during the debriefing session. The aim of the study is to compare the knowledge and skills acquired by groups of postgraduate critical care nursing students who were exposed to high-fidelity simulation (HFS) by using different debriefing structures.

METHODS

A quasi-experimental crossover design was utilised during the post-tests and objective structured clinical examinations (OSCEs). The students were divided into two groups: one was exposed to HFS with a 3-phase debriefing, and the other was exposed to HFS with a multiphase debriefing. Both groups involved facilitator-guided and video-assisted debriefings.

RESULTS

Overall, the post-test scores (p-value: Phase 1 = 0.001 and Phase 2 = 0.000) and post-OSCE scores (p-value: Phase 1 = 0.002 and Phase 2 = 0.002) support that the group of postgraduate students who underwent HFS with a multiphase debriefing structure gained significantly higher scores compared to the group who underwent HFS with a 3-phase debriefing structure.

CONCLUSION

Debriefing is a critical component of successful simulation. Learning requires assessment that creates constructive criticism based on feedback and reflection. A multiphase debriefing structure, specifically the healthcare simulation after-action review, provides a significant advantage for knowledge and skills acquisition.

Simulation debriefing as part of simulation for clinical teaching and learning in nursing education: A scoping review

AIM

To map the evidence of the simulation debriefing phase in simulation activities of nursing education, to address and inform clinical teaching and learning in nursing.

DESIGN

A scoping review.

METHODS

A systematic review of literature published between 2008-2021 was conducted using CINAHL & ERIC, MEDLINE, EMBASE, APA PsycInfo, the Cochrane Library and JBI Evidence synthesis. Inclusion criteria were primary studies published in English on simulation debriefing at all levels in nursing education.

RESULTS

Of 140 included references, only 80% (N = 112) framed simulation debriefing theoretically either by specific theories/models or as a literature review of the topic. A variety of simulation debriefing methods were identified; however, debriefing methods were only described in 79% (N = 110) of the references. There appears to be a gap in consensus concerning the theoretical or methodological frameworks characterizing simulation debriefing in nursing education. The majority of studies (86%) were conducted at a bachelor's degree level (N = 121).

Using an OSCE to Explore the Role of Structured Debriefing and Self-Directed Learning in Simulator-Based Clinical Skill Training in Production Animal Reproductive Medicine

Self-directed learning is associated with several benefits in simulation-based clinical skill training and can be complemented by feedback in the form of post-event debriefing. In this study, final-year veterinary medicine students (n = 111) were allocated into one of three groups and practiced four clinical skills from the domain of production animal reproductive medicine in a clinical skills laboratory. Group 1 completed an instructor-led practice session (I), group 2 completed a self-directed practice session with post-event debriefing (D), and group 3 completed a self-directed practice session without debriefing (control, C). Each practice session included two clinical skills categorized as being directly patient-related (patient) and two clinical skills involving laboratory diagnostics or assembling equipment (technical). Students evaluated the practice session using Likert-type scales. Two days after practice, 93 students took part in an objective structured clinical examination (OSCE). Student performance was analyzed for each learning station individually. The percentage of students who passed the OSCE did not differ significantly between the three groups at any learning station. While the examiner had an effect on absolute OSCE scores (%) at one learning station, the percentage of students who passed the OSCE did not differ between examiners. Patient learning stations were more popular with students than technical learning stations, and the percentage of students who passed the OSCE was significantly larger among students who enjoyed practicing at the respective station (90.9%) than among those who did not (77.8%).

Learning Experience and Clinical Outcomes with Standardized Patient Simulation: A Mixed Qualitative and Quantitative Study

PURPOSE

To evaluate learning experience and clinical outcomes after intervention.

DESIGN

A mixed study.

METHODS

A multiple cohort sample (n=75) of community nurses underwent an SP simulation. A survey and 12- and 24-month incident data were used to evaluate the learning experience and clinical outcomes.

FINDINGS

The nurses were highly satisfied with their learning. In addition, their ability to identify near-misses and the presence of incidents showed a statistically significant improvement (p < .05).

CONCLUSIONS

SP simulation effectively improved learning experience and clinical outcomes regardless of nurses' experience.

CLINICAL EVIDENCE

Simulation learning can have a positive impact on clinical outcomes.

Telephone-Based Structured Communication Simulation Program for the Follow-Up of COVID-19 Cases and Contacts in Primary Care

(1) The COVID-19 pandemic has had many consequences on health systems worldwide. In the Spanish health system, telephone-based consultations were coupled to in-person consultations. This type of consultation was mainly a challenge for the primary care teams, who had to assume the greatest load of care provision. The objective of the present study was to discover the satisfaction and perception of health professionals related to a training program on efficient communication based on high-fidelity simulation. (2) Methods: A cross-sectional descriptive study based on a convergent and parallel mixed method. The satisfaction and perception of 275 health professionals associated with COVID-19 training based on the structured communication model CERCAR© was analyzed. (3) Results: The assessment of the satisfaction with the training and methodology was high. With respect to the transfer of information, the participants gave a high score to the categories of consolidation of learning, applicability to their work, and benefits for the institution. The qualitative results supported these findings. (4) Conclusions: The training program and its virtual modality were well received, and had a high degree of transference. The application of active, online learning methodologies is a relevant format for continuous education.

What do I take home after the simulation? The importance of emergent learning outcomes in clinical simulation

BACKGROUND

Clinical simulation learning includes a debriefing after the simulated experience. Debriefing consists of several stages. In this work we focus on the last stage (summary or transfer phase), in which the participants present the most relevant of what they learned during the session.

OBJECTIVES

To analyze the perception of 4th year Nursing Degree students on the most significant aspects they learned during the simulation sessions.

METHOD

A qualitative, cross-sectional and descriptive study was conducted, with students in their last year of the Nursing Degree at the Catholic University of Murcia. The opinions of 67 students from 5 groups, on the debriefing phase, were analyzed, by comparing them with the objectives that were initially proposed during the design of the scenarios used in the simulations.

RESULTS

A total of 78 clinical scenarios were analyzed, with 292 pre-established learning objectives, on a total sample of 67 students. The participants provided a total of 464 learning outcomes that were significant for them, of which 101 coincided with those that were initially planned (21.8%), while the rest, 363 (78.2%), were considered emergent (not planned a priori). For the most part, the learning outcomes described by the students were technical knowledge and/or skills (70.5%), as compared to non-technical knowledge and/or skills (29.5%).

CONCLUSION

For the most part, the learning outcomes considered by the students to be significant did not correspond with the objectives set a priori in the design of the scenarios. Most were emergent elements, especially those that referred to the technical knowledge and skills. The emergent knowledge must be considered crucial by the educators for the teaching and training of students.

A rollercoaster of emotions: An integrative review of emotions and its impact on health professional students' learning in simulation-based education

AIM

Simulation-based education establishes a specific learning environment capable of activating emotions before, during and after the task. Research has identified stress and anxiety related to simulation. However, the role of various emotional experiences in a simulation that favour learning is still unclear. This review describes, interprets and synthesizes the current research findings on health professional students' experience of emotions and the effects on student learning in simulations.

DESIGN

This study design was guided by integrative review method.

METHODS

Databases were systematically searched for articles. 9,323 records were screened and 16 studies met the inclusion criteria. The study protocol was reported in Prospero.

RESULTS

Three themes emerged from the analysis: (a) simulation as a fearful and stressful situation, (b) variability in emotions experienced during simulation as a rollercoaster of emotions and (c) emotions wide-ranging effects on students' learning in the simulation.

Examining the Role of Structured Debriefing in Simulator-Based Clinical Skills Training for Namibian Veterinary Students: A Pilot Study

Post-event debriefing has been described as an effective tool in improving learning achievements in simulator-based teaching. This article examines the effect of structured post-event debriefing sessions in simulator-based veterinary clinical skills training. Nineteen Namibian veterinary students took part in instructor-led practice, self-directed practice with structured post-event debriefing and self-directed practice without debriefing (control) at three different learning stations in a veterinary clinical skills laboratory. Students evaluated their practice experience using Likert-type scales, and learning achievements were assessed using an objective structured clinical examination (OSCE). The results show that the choice of practice model had no significant effect on learning achievements overall. However, at individual learning stations, different practice models showed significant differences regarding effect on learning achievements. Students generally preferred practice sessions with some form of instructor involvement but the importance of instructor guidance was rated differently at each individual learning station.

Satisfaction and Beliefs on Gender-Based Violence: A Training Program of Mexican Nursing Students Based on Simulated Video Consultations during the COVID-19 Pandemic

The increase in gender-based violence in light of the COVID-19 pandemic is a public health problem that needs to be addressed. Our study aimed to describe the satisfaction with a training program in gender violence victim’s attention through simulated nursing video consultations, analyze the beliefs on gender violence in Mexican undergraduate nursing students, and understand the skills that need to be improved. A descriptive cross-sectional study using a mixed-method was carried out with 27 students using a validated satisfaction questionnaire (quantitative data) and conducting scripted interviews (qualitative data) analyzed through the interpretive paradigm. All nursing students expressed a high overall satisfaction with simulated nursing video consultations and positive perceptions about this training program. From the students’ perceptions, three first-level categories and their related second-level and specific categories emerged: belief and myths, skills to improve, and learning improvements. A training program in gender violence victim’s attention through simulated nursing video consultations, in the middle of a pandemic, was a satisfactory experience for nursing students and beneficial for them, as they gained new knowledge and socioemotional skills. This training program mainly improved the acquisition of communication and emotional management skills for an adequate gender violence victim’s attention.

The Role of Debriefing in a Community Health Study Abroad

Study abroad experiences offer nursing students the opportunity to develop cultural competence and sensitivity while providing care within the context of a different culture. Debriefing is a strategy that engages students in conversation and active reflection to process emotions, examine personal values, and synthesize knowledge gained from active learning experiences. While debriefing can enhance learning outcomes in study abroad programs, there is currently a paucity of literature that explores its use within the context of study abroad. In this article, we describe a structured debriefing approach we use in an international community health clinical experience. We conclude with a discussion of the lessons we have learned to improve the effectiveness of our debriefing sessions and recommendations for future research.

Comparing formative and summative simulation-based assessment in undergraduate nursing students: nursing competency acquisition and clinical simulation satisfaction

BACKGROUND

Formative and summative evaluation are widely employed in simulated-based assessment. The aims of our study were to evaluate the acquisition of nursing competencies through clinical simulation in undergraduate nursing students and to compare their satisfaction with this methodology using these two evaluation strategies.

METHODS

Two hundred eighteen undergraduate nursing students participated in a cross-sectional study, using a mixed-method. MAES© (self-learning methodology in simulated environments) sessions were developed to assess students by formative evaluation. Objective Structured Clinical Examination sessions were conducted to assess students by summative evaluation. Simulated scenarios recreated clinical cases of critical patients. Students´ performance in all simulated scenarios were assessed using checklists. A validated questionnaire was used to evaluate satisfaction with clinical simulation. Quantitative data were analysed using the IBM SPSS Statistics version 24.0 software, whereas qualitative data were analysed using the ATLAS-ti version 8.0 software.

RESULTS

Most nursing students showed adequate clinical competence. Satisfaction with clinical simulation was higher when students were assessed using formative evaluation. The main students' complaints with summative evaluation were related to reduced time for performing simulated scenarios and increased anxiety during their clinical performance.

CONCLUSION

The best solution to reduce students' complaints with summative evaluation is to orient them to the simulated environment. It should be recommended to combine both evaluation strategies in simulated-based assessment, providing students feedback in summative evaluation, as well as evaluating their achievement of learning outcomes in formative evaluation.

Twelve tips for effective simulation debriefing: A research-based approach

Evidence strongly supports simulation-based learning activities as an effective instructional intervention. The debriefing session associated with a simulation event is one of, if not the critical, learning component within the learning activity. Because of its importance, the debriefing portion of a simulation should demand as much planning and forethought as the rest of the event; however, it is often overlooked in the planning process. These twelve steps will help guide faculty who are planning simulation-based learning activities to ensure that their debriefing sessions are effective and successful learning opportunities.

Mixed-method study on the satisfaction of a high-fidelity simulation program in a sample of nursing-degree students

BACKGROUND

Training emotionally complex communication skills with standardized patients brings realism to simulation scenarios, and moreover, is associated with high levels of satisfaction among the students.

OBJECTIVES

(1) To measure the satisfaction of nursing students and factors related to their satisfaction and (2) to explore the effects perceived by nursing students after having a high-fidelity simulation training program using standardized patients.

DESIGN AND PARTICIPANTS

Mixed design. Pre-post quasi-experimental phase in which the Satisfaction Scale Questionnaire with High-Fidelity Clinical Simulation was administered in 156 students; a second, semi-structured interview qualitative phase was completed by 11 students.

RESULTS

Nursing students showed high satisfaction scores. The scores for utility and communication were correlated with the students' attitudes towards communication. In the second phase, two main themes and four sub-themes emerged.

CONCLUSIONS

Teachers could implement high-fidelity simulation programs with standardized patients for training emotionally complex communication skills to nursing students. These programs allow students to participate in their own learning processes and help them to feel motivated and satisfied about the usefulness of their learning experiences.

Twelve tips for facilitating and implementing clinical debriefing programmes

Contemporary clinical practice places a high demand on healthcare workforces due to complexity and rapid evolution of guidelines. We need embedded workplace practices such as clinical debriefing (CD) to support everyday learning and patient care. Debriefing, defined as a 'guided reflective learning conversation', is most often undertaken in small groups following simulation-based experiences. However, emerging evidence suggests that debriefing may also enhance learning in clinical environments where facilitators need to simultaneously balance psychological safety, learning goals and emotional well-being. This twelve tips article summarises international experience collated at the recent Association for Medical Education in Europe (AMEE) debriefing symposium. These tips encompass the benefits of CD, as well as suggested approach to facilitation. Successful CD programmes are frequently team focussed, interdisciplinary, implemented in stages and use a clear structure.

High-Fidelity Virtual Objective Structured Clinical Examinations with Standardized Patients in Nursing Students: An Innovative Proposal during the COVID-19 Pandemic

In response to the cancellation of in-person objective structured clinical examinations (OSCEs) prompted by confinement due to the COVID-19 pandemic, we designed a solution to adapt our traditional OSCEs to this new reality in nursing education. We implemented an innovative teaching proposal based on high-fidelity virtual OSCEs with standardized patients. The purposes of our study were to describe this innovative teaching proposal and compare nursing competence acquisition in final year nursing students through virtual and in-person OSCE modalities. The study included 234 undergraduate students: 123 students were assessed through high-fidelity virtual OSCEs during May 2020, whereas 111 students were assessed through in-person OSCEs during May 2019. The structure of OSCEs, including its stations, clinical simulated scenarios, and checklists, was the same in both OSCE modalities. The effect size of the differences among the competence categories of checklists, including their total scores, was small. Regarding our virtual OSCEs was similarly successful to in-person OSCEs, this online format was found to be useful, feasible, and cost-saving when in-person OSCE was not possible. Therefore, high-fidelity virtual OSCEs with standardized patients could be considered as another choice of OSCE not only in the current COVID-19 pandemic but could also be extended to normal situations, even post-pandemic.

Nurses Who Assume the Role of Advocate for Older Hospitalized Patients: A Qualitative Study

INTRODUCTION

Patient advocacy, acting on behalf of patients' unmet needs, is fundamental to nursing, and the perception of the need for advocacy motivated this study. Nurses experience moral discomfort, which results from a divergent view regarding medical or caregivers' decisions about patients' clinical proceedings, in which patients' involvement in making those decisions is either doubtful or absent.

OBJECTIVES

The aim of this study is to assess the need for advocacy and explore the perspectives of nurses engaged in the care of older patients.

METHODS

The methodological orientation is that of a qualitative design, by using a purposive and criterion sampling. The sample was of 14 nurses of a ward of general medicine. Focus group as collecting data tool was used, followed by a thematic analysis.

RESULTS

Nurses demonstrated a high level of moral sensitivity to ethical problems in clinical practice and on occasions, the courage to bring the problem to the physicians or patients' family's attention, or help patients develop self-determination. However, it is difficult to advocate because of insufficient communication between professionals, insufficient knowledge of ethics, and the emotional burden it places on nurses which results in emotional resignation in the face of interprofessional teams' lack of consideration of nurses' opinions.

CONCLUSION

This research highlighted nurses' need for advocacy to promote patients' rights, wishes, and values. It is essential for nurses to be aware of their level of moral sensitivity and develop a strategy to regain courage to engage in advocacy. Therefore, ethics education and interprofessional ethical leadership is desired, which inspires healthcare professionals' work and allows the foundations of an ethical decisionmaking process to be laid through patients and their families' active involvement.

Reversible causes of cardiac arrest: Nursing competency acquisition and clinical simulation satisfaction in undergraduate nursing students

BACKGROUND

It is essential to determine and treat the reversible causes of cardiac arrest, so emergency nurses must acquire the competencies needed for its adequate management.

METHOD

106 undergraduate nursing students participated in a cross-sectional study, using a mixed-method. Simulated scenarios recreated critically ill patients with diagnoses of potentially reversible causes of cardiac arrest in an emergency room. An internally validated questionnaire was used to analyse students' satisfaction and perceptions about clinical simulation sessions. Nursing competencies were assessed using a verification list. Data were analysed using the IBM SPSS Statistics version 24.0 (quantitative data) and ATLAS-ti version 8.0 (qualitative data) software.

RESULTS

Nursing students expressed a high level of satisfaction (most of the scores obtained were higher than 90%) and positive perceptions about clinical simulation sessions. Most of the students (85.6%) acquired the necessary nursing competencies for adequate management of the reversible causes of cardiac arrest.

CONCLUSION

Clinical simulation methodology is a useful tool for the learning process and acquisition of nursing competencies related to emergency situations management. This methodology prepares nursing students for their clinical placements and future careers in emergency care. Therefore, it is recommended to extend clinical simulation training to emergency qualified nursing staff and advanced practitioners.

Focusing on explicit debriefing for novice learners in healthcare simulations: A randomized prospective study

INTRODUCTION

Debriefing is essential in simulation-based training, but it is not clear what exactly constitutes a successful debriefing session. Research in educational sciences shows that a structured, explicit and trainer-directed approach is systematically more effective than an implicit, reflective approach with minimal guidance, particularly for novice or intermediate learners. The aim of this study is to compare explicit strongly trainer-guided debriefing with implicit and weakly guided debriefing in nursing training.

METHOD

Single-centre randomized prospective study comparing effectiveness of explicit and implicit debriefing techniques. We focused on the description and the analysis phases of the debriefing. Our main aim was to assess the effectiveness of debriefing in terms of knowledge improvement. We also assessed its effectiveness for self-efficacy and self-confidence.

RESULTS

136 nursing students participated in 46 simulation sessions. Knowledge, self-efficacy and self-confidence increased in all conditions. The results also showed that debriefing with explicit analysis improved learning significantly when compared to the control session.

CONCLUSION

Although the results revealed a beneficial effect of simulation training on self-efficacy, the explicit debriefing technique was shown to produce greater knowledge improvement than the implicit debriefing method in novice learners. Consequently, debriefing technique should be adapted to the objectives of the training and learners.

Interdisciplinary clinical debriefing in the emergency department: an observational study of learning topics and outcomes

Background

Defined as a ‘guided reflective learning conversation’, ‘debriefing’ is most often undertaken in small groups following healthcare simulation training. Clinical debriefing (CD) following experiences in the working environment has the potential to enhance learning and improve performance.

Methods

Prior to the study, a literature review was completed resulting in a standardised approach to CD that was used for training faculty. A pilot study of CD (n = 10) was then performed to derive a list of discussion topics and optimise the faculty training. The resulting debriefing approach was based on the “S.T.O.P.” structure (Summarise the case; Things that went well; Opportunities for improvement; Points of action). A debriefing aid, with suggested scripting, was provided. A subsequent observational study assessed CD within 1-h of clinical events. ‘Significantly distressing’ or ‘violent’ events were excluded. Data was collected on participant characteristics, discussion topics, and team recommendations. Study forms were non-identifiable. Subsequent analysis was performed by two investigators using content analysis of the debriefing forms (n = 71). Discussion topics (learning points) were coded using a modified version of the Promoting Excellence and Reflective Learning in Simulation (PEARLS) framework. One month after completion of the study, ED management staff were surveyed for reports of “harm” as the result of CD.

Results

During the study period, 71 CDs were recorded with a total of 506 participants. Mean debriefing length was 10.93 min (SD 5.6). Mean attendance was 7.13 (SD 3.3) participants. CD topics discussed were divided into ‘plus’ (well-done) and ‘delta’ (need to improve) groupings. 232 plus domains were recorded of which 195 (84.1%) aligned with the PEARLS debriefing framework, suggesting simulation debriefing skills may be translatable to a clinical setting. Topics discussed outside the PEARLS framework included family issues, patient outcome and environmental factors. CD reports led to preventative interventions for equipment problems and to changes in existing protocols. There were no recorded incidents of participant harm resulting from CD.

Conclusions

Topics discussed in CD predominantly aligned to those commonly observed in simulation-based medical education. Collective recommendations from CD can be used as evidence for improving existing protocols and models of care.

Developing reflective competence between simulation and clinical practice through a learning transference model: A qualitative study

OBJECTIVE

This study sought to understand the effects of a pedagogical resource combining a multi-moment debriefing model with reflective journaling that is designed to develop reflective competence.

DESIGN

A qualitative educational study was used with an instrumental case study design. Participating in the study were 32 nursing students who wrote 96 individual reflective journals in accordance with each moment (M1, M2, M3) of the proposed reflective practice resource. The journaling was conducted during both the clinical simulation activity and the period of clinical practice.

METHODS

The reflective journals resulting from the high-fidelity clinical simulation process were used to explore three moments of learning: debriefing immediately after simulation, post-scenario debriefing, and clinical practice. The typology of content analysis used was classical content analysis, which followed a deductive logic, since to assess reflection levels the 5Rs Reflective Writing Scale was used.

RESULTS

In the post simulation moment (M1), students produced a greater number of meaningful units associated with a level of strategic narrative reflection. During clinical practice however reflection was more analytical, with the highest level of reflection.

CONCLUSION

Nursing students developed reflective competence through an iterative process of reflective practice establishing a continuum between simulation experience and clinical.

Simulated Video Consultations as a Learning Tool in Undergraduate Nursing: Students' Perceptions

Simulated video consultations, a teaching tool based on high-fidelity simulations, were implemented in response to the necessary adaptation of high-fidelity clinical simulation sessions to the online or virtual modality during the university closure due to the COVID-19 confinement. The purpose of our study was to explore the undergraduate nursing students’ satisfaction and perceptions about simulated video consultations using the high-fidelity simulation methodology. A mixed-method was utilized with 93 undergraduate nursing students using a validated satisfaction questionnaire (quantitative data), which included an observations section (qualitative data). Of the total sample, 97.8% of the students expressed a high overall satisfaction with simulated video consultations, highlighting their practical utility and positive learning outcomes. From the students’ comments, two main themes and their related categories emerged: advantages (satisfaction and enjoyment, learning, and calmness during simulated scenarios), and disadvantages (technical issues and technical skills development). Simulated video consultations may be considered as one more high-fidelity simulation teaching option. Nursing students should be trained in this modality of healthcare to face the challenge brought on by its increased use in healthcare services, beyond the specific adaptation of clinical simulation sessions due to the closure of universities during this pandemic.

Simulated Nursing Video Consultations: An Innovative Proposal During Covid-19 Confinement

Background

In response to the closure of universities and the canceling of in-person classes due to the COVID-19 pandemic, this study was designed to focus on a solution for adapting simulation-based education to this situation.

Method

A mixed study was conducted to analyze nursing students' satisfaction and perceptions (n = 48) about simulated nursing video consultations.

Results

Nursing students expressed a high level of satisfaction and positive perceptions about this innovative proposal.

Conclusions

Simulated nursing video consultations could be considered as another choice of high-fidelity simulation not only in the current COVID-19 situation, but its use could be extended to other contexts.

Applications of Postresuscitation Debriefing Frameworks in Emergency Settings: A Systematic Review

OBJECTIVES

Postresuscitation debriefing (PRD) is a valuable educational tool in emergency medicine. It is recommended by international resuscitation guidelines, has been shown to improve both patient outcomes and resuscitation team performance, and is frequently requested by medical learners. However, there is limited research comparing standardized debriefing frameworks. Not only does this hinder the ability of interested emergency departments (EDs) to adopt PRD, but it limits the quality of future debriefing research. We sought to identify and compare existing PRD frameworks to inform the implementation of effective PRD in emergency medicine.

METHODS

We conducted a systematic review following PRISMA standards to identify debriefing frameworks used in the ED and other acute care settings for further analysis. Identified frameworks were analyzed and compared based on a method previously described in the literature.

RESULTS

Our search identified six frameworks, which ranged from simple tools for immediate feedback to complex, hospital-wide systems engineering-based approaches to quality improvement. Key findings were the importance of ensuring debriefing facilitators are properly selected and trained and of tailoring framework design to specific organizational targets. However, there is limited validation data for these frameworks, and more study is needed to identify and validate true best practices in PRD.

CONCLUSIONS

All six identified frameworks seem to be effective methods of debriefing. Given the breadth in debriefing methods and goals identified, this suggests that there may not be a one-size-fits-all approach to PRD and that organizations should instead identify their own unique needs and barriers and adopt the debriefing framework that best addresses those needs. Other findings were the importance of well-trained debriefing facilitators and the use of clear roles in organizing debriefings. Further research is needed to assess the effectiveness of postresuscitation frameworks with regard to both team performance and patient outcomes.

Debriefing methods and techniques used in nursing simulation

OBJECTIVE

To identify in the literature methods and techniques of debriefing used in teaching and learning in nursing simulation.

METHODS

Integrative review of PubMed/MEDLINE®, LILACS, Scopus and CINAHL® databases, with the descriptors "nursing", "nursing education", respective terms in English and Spanish, and the keyword "debriefing". Twelve primary studies, in Portuguese, English and Spanish, from January 2008 to December 2018 were included. Qualitative analysis was used to categorize the domains.

RESULTS

The identified meaningful learning methods were based on principles of transfer of learning; model of clinical reasoning, interprofessional, with good judgment and structured and self-debriefing techniques, oral, eye-tracking, video-assisted and written debriefing.

CONCLUSIONS

The structured method and the oral technique with video were outstanding. One method was not superior to the other but effective for a particular proposal. No national studies have been found. Research should be conducted on the effectiveness of nursing debriefing methods and techniques.

Effectiveness of simulation learning program for mastering public health nursing skills to enhance strength of community: A quasi-experimental design

PURPOSE

The purpose of this study is to develop a simulation learning program for mastering public health nursing skills to enhance strength of community, and to verify its effectiveness.

METHODS

The program is one-day session to master the skills from three exercises. This study adopts a quasi-experimental design. We selected unbiased 34 participants in intervention group and 30 participants in control group, and conducted self-administered questionnaire surveys at three points in time: pre, post 1 and post 2. Three tools were used to measure the required outcome. For the outcome evaluation, we calculated the changes in the mean value of each tool between pre and post 1 and between pre and post 2, and compared them between the two groups.

RESULTS

The change of intervention group in the total score at the post 1 stage from the pre stage was significantly higher than control group regarding each of the scales (P < .05).

CONCLUSIONS

The program was found to be effective in upgrading the skills of less-experienced public health nurses to enhance strength of community.

Development and Evaluation of a Home-visit Simulation Scenario for Elderly People with Diabetes Mellitus Who Live Alone

Purpose: Developing and evaluating a simulation scenario for community nursing practicum students.Design: One group, pretest posttest design with 87 nursing students.Methods: Data were collected through questionnaires. The simulation was based on Jeffries' simulation model and used a standardized patient.Findings: Self-efficacy and critical thinking increased with the developed simulation. Positive correlations were identified among critical thinking, learning effectiveness, and self-efficacy.Conclusions: The home-visit simulation scenario was effective in providing students with a problem-solving experience in conditions similar to reality.Clinical Evidence: Further research is needed to develop various types of community simulation scenarios to enhance competency for community health practice.

Comparison of the effects of simulation training and problem-based scenarios on the improvement of graduating nursing students to speak up about medication errors: A quasi-experimental study

BACKGROUND

Medication administration errors are common among new nurses. Nursing students might be less willing to speak up about errors because of a lack of knowledge and experience.

OBJECTIVES

To examine the effects of simulation training and problem-based scenarios on speaking up about medication errors among graduating nursing students.

DESIGN

Prospective, controlled experimental study design.

SETTING

A university four-year nursing program in Taiwan.

PARTICIPANTS

In total, 93 graduating nursing students in their last semester were recruited. Sixty-six students who received both a problem-based scenario and medication administration simulation training comprised the experimental group, while 27 students who received problem-based scenarios alone comprised the control group.

METHODS

Experimental group students underwent 2 h of simulation training. This training class was designed based on Kolb's experiential learning theory for knowledge development and speaking up about errors. Students in both groups administered medications in problem-based scenarios with eight embedded errors. Students' performance in speaking up about medication errors was directly observed and graded using an objective structured checklist. The McNeamer Chi-squared test, paired t-test, Z test, t-test, and Hedges' g effect size were conducted.

RESULTS

The number of times participants spoke up about medication errors significantly improved in both the experimental group (pre-test: 2.05 ± 1.12 and post-test 6.14 ± 1.25, t = 22.85, p<0.001) and control group (pretest: 2.04 ± 1.16 and post-test: 4.26 ± 1.63, t = 6.33, p<0.001). However, after the intervention, the mean number of times participants spoke up about medication errors in the experimental group was significantly higher than that in the control group (t = 5.99, p<0.001) in the post-test.

CONCLUSIONS

Simulation training exhibited more-significant improvements than problem-based scenarios. Nursing schools and hospitals should incorporate simulation training or at least problem-based scenarios to improve medication safety.

Effects of peer-led debriefing using simulation with case-based learning: Written vs. observed debriefing

BACKGROUND

Peer-led written debriefing (PLWD) and peer-led observed debriefing (PLOD) are types of peer-led debriefing. Despite their advantages, these methods are sparingly used among debriefing experts.

OBJECTIVE

To identify effects of peer-led debriefing (written versus observed) using simulation with case-based learning (CBL) and compare levels of satisfaction with CBL, debriefing, and simulation-based learning (SBL) between the two groups.

DESIGN

Quasi-experimental study used a pretest-posttest non-equivalent control group.

SETTING

Department of Nursing in C province, South Korea.

PARTICIPANTS

Sixty-nine third-year undergraduate nursing students (PLWD, n = 33; PLOD, n = 36).

METHODS

Differences in clinical performance competency, and satisfaction of CBL, SBL, and debriefing between the PLWD and PLOD groups were determined.

RESULTS

Clinical performance competency scores of posttest in both the PLWD and PLOD groups were significantly higher than those of pretest. There were no significant differences in any item except for item of 'communication' (t = -2.150, p = .047) between the PLWD and PLOD groups. There were no significant differences in satisfaction with CBL (t = -0.874, p = .385), simulation (t = -0.701, p = .485), or debriefing (t = -1.024, p = .309) between the two groups.

CONCLUSION

This study suggests that both the PLWD and PLOD could be used to achieve students' learning outcomes when debriefing experts are unavailable.

The "Timeline Debriefing Tool": a tool for structuring the debriefing description phase

Several recent literature reviews have been published with the aim to determine how to optimise a debriefing. A main element found in these reviews was the importance of structuring the debriefing. Within the steps usually outlined in the debriefing, the description phase allows participants to describe their recollections and establish a shared mental model of what happened during the simulation. The description phase is used in many debriefing models but how to realise this description remains unclear. We provide an original tool to ensure a highly structured description phase: the “Timeline Debriefing Tool”.

The Timeline Debriefing Tool, or TDT, is constructed on visual support such as a whiteboard or a flipchart. It allows for a clear description phase, makes the process more dynamic, promotes exchanges between participants and establishes a clear and shared vision of the simulation in visual support which can be used by the instructor in the analysis phase. Moreover, the timeline allows participants to discover their performance gaps by themselves, thus beginning deeper cognitive processing in the participants’ mind and promoting reflection in the analysis phase.

Effects of post-scenario debriefing versus stop-and-go debriefing in medical simulation training on skill acquisition and learning experience: a randomized controlled trial

BACKGROUND

Debriefing is a critical component to promote effective learning during simulation-based training. Traditionally, debriefing is provided only after the end of a scenario. A possible alternative is to debrief specific portions during an ongoing simulation session (stop-and-go debriefing). While this alternative has theoretical advantages, it is not commonly used due to concerns that interruptions disturb the fidelity and adversely affect learning. However, both approaches have not been rigorously compared, and effects on skill acquisition and learning experience are unknown.

METHODS

We randomly assigned 50 medical students participating in a simulation-based cardiopulmonary resuscitation training to either a post-scenario debriefing or stop-and-go debriefing. After four weeks, participants performed a repeat scenario, and their performance was assessed using a generic performance score (primary outcome). A difference of 3 or more points was considered meaningful. A 5-item questionnaire was used to assess the subjective learning experience and the perceived stress level (secondary outcomes).

RESULTS

There was no significant difference between the groups for the performance score (mean difference: -0.35, 95%CI: -2.46 to 1.77, P = 0.748, n = 48). The confidence limits excluding the specified relevant 3-point difference suggest equivalence of both techniques with respect to the primary outcome. No significant differences were observed for secondary outcomes.

CONCLUSIONS

Stop-and-go debriefing does not adversely affect skill acquisition compared to the classic post-scenario debriefing strategy. This finding is reassuring when interruptions are deemed necessary and gives simulation instructors the latitude to tailor the timing of the debriefing individually, rather than adhering to the unsupported dogma that scenarios should not be interrupted.

TRIAL REGISTRATION

As this study is not a clinical trial, it was not registered in a clinical trials register.

Descriptive study of the satisfaction of nursing degree students in high-fidelity clinical simulation practices

OBJECTIVE

To describe the level of satisfaction of nursing students with clinical simulation in their undergraduate training.

METHOD

a descriptive observational study of a retrospective cross section was conducted in undergraduate students in Nursing during the academic years 2016-17 and 2017-18. The instrument used was the High Fidelity Clinical Simulation satisfaction scale in students (ESSAF), a validated, anonymous and self-administered questionnaire (alpha .857) to measure the level of satisfaction after high-fidelity clinical simulation practices.

RESULTS

Data were collected from a total of 269 students, of which 63.3% were women and the average age of the sample was 21.68±13.46 years. The analysis of frequencies shows results of the grade of satisfaction over 89%, especially in decision-making, the ability to prioritize and learning procedures. Of the answers, 87% exceeded an average of 4 out of 5. The questions in the questionnaire with answers higher than 4.6 were the realism of the cases (4.71), the teacher provides constructive feedback after each session (4.65), the simulation relates theory to practice (4.72), the analysis (debriefing) at the end of the session helps reflection on the cases (4.65) and practical utility (4.69).

CONCLUSIONS

Nursing students from the University of Cantabria (Spain) report high satisfaction in high fidelity clinical simulation, confirming its usefulness in the learning process.

Nurse simulation facilitator experiences learning open dialogue techniques to encourage self-reflection in debriefing

OBJECTIVES

Simulation debriefing skills are inadequate. Barriers to effective debriefing include a lack of understanding of the meaning of debriefing and time to learn necessary skills. In nursing, students have reported simulation debriefs are used for assessment purposes, with little opportunity or time for reflection, affecting their learning. This study reports on an intervention to support nursing simulation facilitators to develop and learn self-reflective learning skills to use when facilitating simulation debriefs.

DESIGN

The authors designed and developed a six-hour workshop. The published simulation literature and Open Dialogue techniques informed the skill set included in the workshop. Open Dialogue is a therapeutic approach used in mental health care.

PARTICIPANTS

Twelve (N = 16, n = 12) female nurses who regularly facilitate simulations for nursing students were purposively recruited to the study.

METHODS

This evaluation study utilised a modified version of a previously validated self-reported reflective learning questionnaire for participants to rate their experiences of the workshop. The modified questionnaire comprised 17 items across four subsets and utilised a five point Likert scale. Open-ended questions were also included.

RESULTS

Eight questionnaires were returned. High scores indicated the participant's positive evaluation of the workshop in developing a skill set to promote self-reflective learning, together with analysing emotions in everyday professional situations and in communication skills.

CONCLUSIONS

Participants reported the intervention was beneficial to their professional development and in helping them to develop their own self-reflective learning skills. The skill set included in the workshop was helpful to nursing simulation facilitators and could be one way to enhance nursing simulation facilitators debriefing skill set.

Nursing students’ experience in performing intimate clinical procedures via high fidelity Mask-Ed simulation

Background

Didactic clinical skills training employing low fidelity simulation has been the traditional approach to teaching undergraduate nursing students the insertion of an indwelling urinary catheter. This approach, however, does not adequately prepare students for the intricacies and complexity of this procedure in the real world, which is associated with high rates of infection secondary to procedural contamination.

Objectives

To explore students’ confidence levels in developing clinical psychomotor skills associated with the insertion of an indwelling urinary catheter in a high-fidelity simulation using Mask-Ed.

Methods

A mixed methods study was conducted involving final year Bachelor of Nursing students. Preproceduraland postprocedural confidence was rated by students using a 5-point Likert scale. A focus group consisting of eleven students was conducted to further explore student’s experience of engaging with a Mask-Ed character and the procedural experience from a learning perspective.

Results

The findings indicated that students increased their procedure confidence when engaging with the Mask-Ed simulation (P=0.025). The ability to maintain procedural asepsis and ability to accurately identify the correct anatomical structures related to indwelling urinary catheter insertion were found to be related (rs=0.71, P<0.05). Three primary themes were identified: caring of a person, intimate care and communication.

Conclusion

Psychomotor skills related to communication, support and maintaining procedural asepsis were areas that required further clinical development, which are not concurrently integrated into the simulation approach using manikin based simulation. Mask-Ed provided a unique learning opportunity to replicate a clinically and anatomically realistic experience.

Breastfeeding Simulation With the Standardized Patient

Despite an emphasis on lactation and the availability of resources to support and sustain lactation, our community hospital's rates of exclusive breastfeeding remained less than the 50% to 70% benchmark recommended by The Joint Commission and the World Health Organization. Concluding that we had exhausted the majority of evidence-based best practices described in the literature, we sought to find a new way to provide an engaging, useful medium for nursing education and improvement of clinical nurses' skills related to breastfeeding. Here, we describe the simulation program we developed using the standardized patient model. Although our rates of exclusive breastfeeding remained unchanged after introducing the simulation program, the experience enabled us to identify inconsistent practices and knowledge gaps.

Assessing quality and resources during campus-wide simulation integration

INTRODUCTION

Our simulation center, supported by four departments (Surgery, OB/GYN, Urology, and Anesthesiology), is accredited as a comprehensive Accredited Educational Institute (AEI) and is now expanding to accommodate all departments on campus.

METHODS

A 61-point questionnaire was administered to 44 stakeholders, representing all of UME and GME. Data were compared for AEI vs. non-AEI activities.

RESULTS

Responses were collected from all 44 groups (100% response rate). Overall, 43 simulation activities were hosted within the AEI and 40 were hosted by non-AEI stakeholders. AEI activities were more likely to be mandatory (93% vs. 75%, p = 0.02), have written learning objectives (79% vs 43%, p < 0.001), and use validated assessment metrics (33% vs. 13%, p = 0.03).

CONCLUSION

These data suggest that the AEI courses are more robust in terms of structured learning and assessment compared to non-AEI courses. Campus-wide application of uniform quality standards is anticipated to require significant faculty, course, and program development.

Debriefing for Professional Practice Placements in Nursing: A Concept Analysis

AIM

The aim of the study was to provide an in-depth analysis on the concept of debriefing for professional practice placements within baccalaureate nursing education.

BACKGROUND

When conducted properly, debriefing leads to positive outcomes on undergraduate nursing students' learning. However, if debriefing is conducted poorly, it can inhibit students' learning. Clarification of debriefing as a concept in professional practice placements is integral to its development and successful use within undergraduate nursing education.

METHOD

The Walker and Avant concept analysis model was used in this study.

RESULTS

The analysis identified four defining attributes (description, emotion, analytical reflection, application), three antecedents (an experience, a supportive and respectful environment, and a competent and knowledgeable debrief facilitator), and three consequences (increased knowledge, increased confidence in knowledge, and increased clinical judgment/clinical decision making).

CONCLUSION

Knowledge of the defining attributes, antecedents, consequences of debriefing, and empiric referents assists educators in developing successful debriefing frameworks and instrument evaluation criteria for use in professional practice placements.