Self-Reflection of Video-Recorded High-Fidelity Simulations and Development of Clinical Judgment

Assessing Clinical Judgment and AACN Domains in Self-Reflection of Video Recorded High-Fidelity Simulation Scenarios

BACKGROUND

Clinical judgment is the hallmark of safe patient care. Nurse educators continue to explore best practices to assist prelicensure nursing students in developing clinical judgment.

PURPOSE

The 3-part purpose of this study was to identify what students learned about themselves related to clinical judgment after viewing their video-recorded high-fidelity simulation scenarios, to assess if video recording is an effective post-debriefing teaching strategy, and to evaluate if the 2021 American Association of Colleges of Nursing (AACN) Domains can be assessed longitudinally.

METHODS

Qualitative interpretive description study of 37 prelicensure nursing students.

RESULTS

Ten codes were derived from 314 excerpts: communication, body language, confidence in self, putting data together, collaboration, leadership, safety, skillfulness, areas of improvement, and growth.

CONCLUSIONS

Longitudinal data showcased the development of clinical judgment, effectiveness of self-evaluation of video recorded simulations as a teaching strategy, and assessment of 5 AACN Domains.

Exploring the Meta-debrief: Developing a Toolbox for Debriefing the Debrief

SUMMARY STATEMENT

Otherwise known as debriefing the debrief, meta-debriefing describes the practice of debriefing simulation facilitators after they have facilitated, or observed, a debriefing. It is a vital component of enhancing debriefing skills, irrespective of where debriefers may be in terms of their professional development journey from novice to expert. We present the following 4 fundamental pillars, which underpin the creation of an impactful meta-debriefing strategy: theoretically driven, psychologically safe, context dependent, and formative in function. Furthermore, we describe various strategies that, underpinned by these 4 key pillars, contribute to a toolbox of techniques that enable meta-debriefers to develop proficiency and flexibility in their practice. We have synthesized and critically reviewed the current evidence base, derived mostly from the debriefing literature, and highlighted gaps to address in meta-debriefing contexts. We hope this article stimulates discussion among simulation practitioners, progresses the science and art of meta-debriefing, and prompts further research so that meta-debriefing can become an integral evidence-based component of our faculty development processes.

Hot Versus Cold Debriefing in a Nursing Context: An Integrative Review

BACKGROUND

Hot debriefing occurs shortly after simulations or real-life events, whereas cold debriefings occur after 24 hours. This integrative review examined the effects of hot versus cold debriefing after simulation on prelicensure students.

METHOD

Whittemore and Knafl's five-stage method was followed. Databases searched included PubMed, CINAHL, Scopus, and PsycINFO. The inclusion criteria were studies published in English that involved prelicensure nursing students and measured the effect of hot or cold debriefing.

RESULTS

Themes emerged from 10 studies and included clinical judgment and decision making, knowledge and skills, participant experiences, reflection, and psychological safety and self-efficacy.

CONCLUSION

Hot debriefing was preferred by participants, but cold debriefing resulted in higher knowledge and skills scores. In addition, students in the cold debriefing group were more conformable and in a safe environment compared with the hot debriefing group. Drawing a strong conclusion was difficult due to heterogeneity in study designs and methods. [J Nurs Educ. 2024;63(10):653-658.].

Effectiveness of video-assisted debriefing versus oral debriefing in simulation-based interdisciplinary health professions education: A randomized trial

AIM

We aimed to compare the debriefing experience, simulation assessment, reflection, anxiety and simulation satisfaction of using oral debriefing versus video-assisted debriefing after a simulated clinical session in an interdisciplinary cohort of health sciences students.

BACKGROUND

Debriefing is a reflective process that takes place after a clinical simulation and that can be performed either in a traditional way (oral) or using video-assisted debriefing.

DESIGN

A randomized controlled trial was conducted in 143 health sciences students (35.7% male, 61.5% female).

METHODS

The simulation scenario was designed to evaluate the procedure for donning and doffing personal protective equipment. Differences in debriefing experience, simulation assessment, reflection, anxiety and satisfaction were assessed.

RESULTS

Regarding debriefing experience, significant differences were observed for the category "learning" (34.9 (6.13) vs. 36.7 (3.89); p = 0.039). For simulation assessment, significantly higher scores for all categories were identified in video-assisted debriefing compared with oral debriefing (p<0.001). There were also significant differences between the oral debriefing versus video-assisted debriefing for the overall score of reflection ability (86.97 (10.55) vs. 90.74 (9.67); p=0.028) as well as for the category "reflective communication" (24.72 (3.77) vs 26.04 (4.07); p=0.047). Perceived satisfaction was significantly higher in the video-assisted debriefing group compared with oral debriefing group (p <0.001). For anxiety, no significant differences were observed between debriefing groups.

CONCLUSION

Video-assisted debriefing after a simulated clinical session improves debriefing experience, simulation assessment, reflection and simulation satisfaction, but does not increase anxiety compared with oral debriefing among health sciences students.

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 effectiveness of online Visually Enhanced Mental Simulation in developing casualty triage and management skills of paramedic program students: A quasi-experimental research study

BACKGROUND

Paramedics who perform patient triaging in case of a mass casualty incident generally receive triage training during their undergraduate educational program. Triage training can be facilitated using various simulation modalities together with theoretical training.

OBJECTIVES

The aim of this study is to determine the effectiveness of online scenario-based Visually Enhanced Mental Simulation (VEMS) on developing the casualty triage and management skills of paramedic students.

DESIGN

The study was conducted using a single-group pre-test/post-test quasi-experimental design.

SETTINGS AND PARTICIPANTS

The study was carried out in October 2020 with 20 volunteer students studying in the First and Emergency Aid program of a university in Turkey.

METHODS

After the online theoretical crime scene management and triage course, students completed a demographic questionnaire and a pre-VEMS assessment. They then took part in the online VEMS training and eventually completed the post-VEMS assessment. At the end of the session, they filed an online survey concerning VEMS.

RESULTS

There is a statistically significant increase in the scores obtained by the students between the pre- and post-educational intervention assessment (p < 0.05). The majority of the students gave positive feedback concerning VEMS as an educational approach.

CONCLUSION

The results show that online VEMS is effective in helping paramedic students acquire casualty triage and management skills and that students thought it was an effective educational approach.

Student-Centered Reflection During Debriefing: A Mixed-Methods Study

BACKGROUND

Guided reflection during a debriefing after the simulation is a critical component of learning and is essential for clinical judgment development. However, the literature describing student-centered reflection during debriefing is only beginning to emerge.

PURPOSE

This study aimed to explore concordance between student-centered reflection concept characteristics and describe students' experiences related to reflection during an optimal simulation debriefing.

METHODS

This was a descriptive, mixed-methods study.

RESULTS

Quantitative responses (N = 175; 67% response rate) confirmed participants' concordance with student-centered reflection concept analysis attributes, antecedents, and consequences. Analysis of open-ended questions highlighted internal and external factors influencing students' reflections. A recurring theme was the importance of faculty and peers in creating a safe, supportive environment for reflections.

CONCLUSIONS

Findings support the concordance of student-centered reflection and provide valuable insights into the internal and external factors influencing this reflection.

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.].

Effectiveness of simulation debriefing methods in nursing education: A systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate debriefing methods' effectiveness on learning outcomes for nursing students.

DESIGN

A systematic review and meta-analysis were applied according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement.

DATA SOURCES

Publications were searched in PubMed, EMBASE, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, and WANFANG (China) databases from inception to 2020.

REVIEW METHODS

Two researchers independently retrieved articles and evaluated their quality. Review Manager version 5.3 software was used to conduct the meta-analysis, following the PRISMA guidelines. Bias risk was assessed using the Joanna Briggs Institute manual. Heterogeneity was assessed by I² statistics. Standardized mean difference (SMD) and 95% confidence intervals (CIs) were used for effect size analysis based on learning outcomes.

RESULTS

Sixteen studies were selected in the systematic review and 13 studies with 1637 nursing students were included in the meta-analysis. Five debriefing methods were used in the intervention group. The analysis showed that Debriefing for Meaningful Learning was more effective on the debriefing quality (SMD = 0.52, 95%CI [0.32, 0.72]), and that video-assisted debriefing was more effective on nursing students' experiences (SMD = 0.30, 95%CI [0.02, 0.58]) and critical thinking (SMD = 0.90, 95%CI [0.65, 1.15]) compared with the usual debriefing. However, written debriefing did not show better effects on students' experiences (SMD = -0.22, 95%CI [-0.51, 0.07]), and peer-led debriefing did not show better effects on the debriefing quality compared with the usual debriefing (SMD = -0.15, 95%CI [-1.43, -0.67]).

CONCLUSIONS

The study indicated that Debriefing for Meaningful Learning and video-assisted debriefing showed a positive impact on nursing education. Future studies that have larger sample sizes, high-quality debriefing methods, robust study designs, and other learning outcomes are required.

Reliability of simulation-based assessment for practicing physicians: performance is context-specific

INTRODUCTION

Even physicians who routinely work in complex, dynamic practices may be unprepared to optimally manage challenging critical events. High-fidelity simulation can realistically mimic critical clinically relevant events, however the reliability and validity of simulation-based assessment scores for practicing physicians has not been established.

METHODS

Standardised complex simulation scenarios were developed and administered to board-certified, practicing anesthesiologists who volunteered to participate in an assessment study during formative maintenance of certification activities. A subset of the study population agreed to participate as the primary responder in a second scenario for this study. The physicians were assessed independently by trained raters on both teamwork/behavioural and technical performance measures. Analysis using Generalisability and Decision studies were completed for the two scenarios with two raters.

RESULTS

The behavioural score was not more reliable than the technical score. With two raters > 20 scenarios would be required to achieve a reliability estimate of 0.7. Increasing the number of raters for a given scenario would have little effect on reliability.

CONCLUSIONS

The performance of practicing physicians on simulated critical events may be highly context-specific. Realistic simulation-based assessment for practicing physicians is resource-intensive and may be best-suited for individualized formative feedback. More importantly, aggregate data from a population of participants may have an even higher impact if used to identify skill or knowledge gaps to be addressed by training programs and inform continuing education improvements across the profession.

Midwifery students better approximate their self-efficacy in clinical lactation after reflecting in and on their performance in the LactSim OSCE

Background

Midwives are expected to support women with lactation initiation and maintenance. Midwifery students engaged in a simulation-based exercise (LactSim OSCE) where they role-played the clinician and the breastfeeding patient by wearing a high-fidelity breast model. We provided participants opportunities for reflecting in and on practice to compare their perceived self-confidence in clinical lactation skills to actual clinical performance. We also describe feasibility of implementing the LactSim OSCE with an emphasis on preparation and time spent on tasks during the OSCE.

Methods

Audio-video recordings from the LactSim OSCE were viewed and assessed using a technical skills checklist by an independent rater and by the study participants as part of the self-reflection. Mixed data on participants’ self-efficacy in clinical lactation, experience with the LactSim OSCE, and self-assessment of clinical performance were collected in survey instruments and a focus group. Time spent on each component and clinical lactation skill during the LactSim OSCE was documented.

Results

Immediately following the LactSim OSCE, participants’ confidence in clinical lactation was high (5.7/7), but after a guided video reflection exercise, their self-efficacy was 4.4/7. Participants spent approximately 2 of the allotted 10 min per case scenario discussing the OSCE logistics due to inadequate preparation. Participants spent approximately 2 min of the total encounter performing hands-on clinical lactation skills by touching, looking at, or using the high-fidelity breast model worn by their peer.

Conclusion

We described the development and evaluation of the first simulated experience in clinical lactation with all three components of fidelity: conceptual, psychological, and physical. Multiple opportunities for reflecting on performance allowed the nurse-midwifery students to evaluate their competence in decision-making, technical, and counseling skills which resulted in a more realistic approximation of their perceived self-confidence in breastfeeding skills. Another innovation of this pilot work is the documentation of how long a learner spends on various tasks relevant to lactation support in a simulated encounter. Our findings highlight the importance of providing multiple opportunities for self-reflection using guided video reflection and checklists for objective self-assessment in the clinical lactation field.

Nurse Educators' Guide to Clinical Judgment: A Review of Conceptualization, Measurement, and Development

AIM

The purpose of this article is to define clinical judgment, examine valid and reliable instruments to measure the construct, review established strategies by which to develop it, and propose key future nursing education research priorities in clinical judgment.

BACKGROUND

A pressing interest in prelicensure nursing students' clinical judgment development has emerged in response to the National Council of State Boards of Nursing project Next Generation NCLEX.

METHOD

Sequential literature reviews uncovered six instruments that measure clinical judgment and 24 studies that demonstrate the effects of high-fidelity simulation on clinical judgment in prelicensure learners.

RESULTS

Six themes emerged: number of simulation-based experience exposures, specific nursing specialty simulations, debriefing and its effect on clinical judgment, assessment, clinical decision-making, and reflection.

CONCLUSION

Based on these results, key future research priorities investigating the effects of interprofessional simulation and simulation in the classroom were identified.

Effects of different methods of reflection on nurses' gaze and judgement in a task using a touch panel

AIMS AND OBJECTIVES

To clarify the effects of different methods of reflection on nurses' gaze and judgement in a task using a touch panel, written and oral methods of reflection were compared.

BACKGROUND

Recently, with the development of ICT, nursing education and learning with ICT have spread. However, there are few studies that have analysed the objective effects of learning with ICT and the effects of different methods of learning.

DESIGN

This study was a randomised controlled trial comparing writing and oral reflection groups.

METHODS

Forty-one nurses were divided into two groups as follows: 21 nurses in the writing group and 20 nurses in the oral group. Eye movements were recorded as subjects performed a task on a touch panel. A still photograph of the hospital room was displayed on the touch panel, and the subjects touched the panel according to the instructions provided. Statistical analyses were performed using the Mann-Whitney test to compare the results between the two groups.

RESULTS

In an observation task using a touch panel of a setting requiring environmental improvement, we found no observable differences between the two reflection methods with regard to gaze and judgement in the overall setting. However, with respect to the items in the setting, the writing group judged with gazing after reflection, whereas the oral group judged without gazing.

CONCLUSIONS

Oral reflection as well as reflective writing had positive effects on observation for tasks requiring overall gaze and judgement. On the other hand, reflective writing promoted the visual verification of items requiring observation in the hospital setting.

RELEVANCE TO CLINICAL PRACTICE

Reflective writing promotes visual verification in nurses in a clinical setting while performing a task using a touch panel.