Student Facilitation of Simulation Debrief: Measuring Reflective Thinking and Self-Efficacy

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.

The Use of Guided Reflection in Simulation-Based Education With Prelicensure Nursing Students: An Integrative Review

BACKGROUND

This integrative review synthesized the findings of studies to determine the uses and outcomes of guided reflection in simulation-based education (SBE) with prelicensure nursing students.

METHOD

A search of Cumulative Index to Nursing and Allied Health (CINAHL) Plus, Education Resources Information Center (ERIC), Education Research Complete (ERC), and PsychINFO using the key words reflection, guided reflection, simulation (nursing education or nursing student), traditional, and baccalaureate identified 18 articles.

RESULTS

Findings suggest facilitation of guided reflection in SBE has a positive effect on leadership development, clinical judgment, student satisfaction, and critical thought. Development of a tool to accurately measure guided reflection is warranted.

CONCLUSION

Current evidence on the use of guided reflection in SBE calls for a major paradigm shift in higher education. Guided SBE experiences enhance participant knowledge, and guided reflection should be used as an innovative teaching strategy in SBE. [J Nurs Educ. 2022;61(2):73-79.].