Three-Phase Video-Assisted Multidisciplinary Team Debriefing in High-Fidelity Blast Simulation through the Advocacy and Inquiry Method

BACKGROUND

Video-assisted debriefing (VAD) combined with the advocacy and inquiry (A&I) technique is a tool that allows video playback of selected segments of a simulation, thereby helping the debriefers structure the session. However, no consensus exists on how to optimally perform a team debriefing. The authors demonstrate and describe the methodology of A&I debriefing in an instructional simulated blast scenario and assess the impact of VAD on residents' technical and nontechnical skills.

METHODS

After institutional review board approval, the authors performed a study with 50 residents who were randomly assigned to 2 groups. Group 1 (control, or no VAD; n = 25) consisted of residents who received oral debriefing by 1 independent faculty member without the recorded video of the simulation. Group 2 (intervention, or VAD; n = 25) consisted of residents who received VAD from the second independent faculty member. These residents repeated the same simulation scenario 1 week after their debrief. Every resident was assessed on the primary and secondary survey, as well as the nontechnical skills, based on the integrated skills score.

RESULTS

The VAD group presented significantly higher values for the integrated skills score ( P < 0.001) compared with the no-VAD group.

CONCLUSIONS

This demonstration of 3-phase VAD emphasizes important aspects of coherent simulation-based training: psychologic safety, A&I, reflection, cognitive frames, prebrief, main debrief, summary, and translation of new discoveries to real-life patient care. The unique audiovisual aspect of the VAD enhanced residents' performance in simulation.

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.

Attitude of cardiac surgery nurses on kinesiophobia management: a qualitative study

OBJECTIVES

This study aimed to investigate the knowledge, attitudes and practical experiences of cardiac surgery nurses regarding kinesiophobia management during early mobilisation.

DESIGN

Using a descriptive qualitative research method, 21 cardiac surgery nurses participated in this study from October 2022 to January 2023, and the interview data were analysed using the Colaizzi 7-step analysis method.

SETTING

Data were collected through in-depth face-to-face or online interviews in a tertiary hospital located in Nanjing, China.

PARTICIPANTS

21 cardiac surgery nurses were interviewed from October 2022 to January 2023.

RESULTS

Two themes were summarised: knowledge, attitude and practice of nurses (high recognition and low participation; low knowledge reserve; low willingness); the promotion and essential elements of kinesiophobia management (efficient health education model; stable medical staff-family caregiver collaboration; simplified clinical protocol; specialist nursing team; clarify the multidisciplinary division of labour).

CONCLUSION

The management of kinesiophobia in patients undergoing cardiac surgery is currently in the developmental phase. It is advisable to give due consideration to emotional support and cognitive training for medical staff. In addition, a workable management plan, consistent with clinical practice, should be formulated through multidisciplinary and medical staff-family caregiver collaboration to optimise patient outcomes.

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.

Debriefing: A Tool to Enhance Education and Practice in NICU

Debriefing, a facilitator-guided reflection of an educational experience or critical incident, is an important tool in improving the safety and quality of practice in the NICU. Unlike feedback, which is often a one-way discussion, debriefing is a purposeful, 2-way reflective discussion which is based on experiential learning theory. The purpose of this article is to review the theoretical basis of debriefing and describe styles and tools for debriefing that can be applied in the NICU.

Can anxiety in undergraduate students in a high-fidelity clinical simulation be predicted? A randomized, sham-controlled, blinded trial

INTRODUCTION

High-fidelity clinical simulation has implied a revolution in health science training. Despite its benefits, some drawbacks could hinder the learning process, especially the anxiety produced during such scenarios.

OBJECTIVES

The aim of the present work is to develop a predictive model capable of determining which students will present high levels of anxiety.

DESIGN

We performed a randomized, sham-controlled, blinded trial in which students were randomly assigned to four scenarios and played one of two possible roles.

METHODS

Before and after the simulation we assessed the anxiety level along with physiological and analytical parameters. The main analyzed outcome was an increase of ≥25% in anxiety compared with baseline.

RESULTS

The type of scenario or the role played had no effect on anxiety. The predictive model presented an Area Under the Receiver Operating Characteristics of 0.798 (95% CI: 0.69-0.90; p < 0.001), with age and systolic blood pressure being protective factors against anxiety.

CONCLUSIONS

Our results showed that the anxiety level developed during simulation could be predicted. The application of this predictive model when associated to appropriate techniques to deal with increased anxiety levels could improve the learning process of medical students during simulations.

Peer Debriefing Versus Instructor-Led Debriefing for Nursing Simulation

BACKGROUND

Debriefing is the reflective process following the simulation experience. We aimed to compare the debriefing assessment and debriefing satisfaction perceived by nursing students who underwent different debriefing methods.

METHOD

An experimental study conducted on three groups (instructor-led debriefing, peer debriefing, and combined debriefing) was performed for 177 nursing students. Differences in the debriefing satisfaction were assessed using the Clinical Experience Simulation scale, the Visual Analogue scale, and the Debriefing Assessment for Simulation in Healthcare (DASH).

RESULTS

VAS scores for satisfaction differed significantly between the instructor-led debriefing, peer debriefing, and combined debriefing groups. In the Clinical Experience Simulation scale, the combined debriefing group was significantly higher compared with instructor-led debriefing. The total score for DASH was significantly higher in the combined debriefing group compared with instructor-led debriefing, and in instructor-led debriefing compared with peer debriefing.

CONCLUSION

Combining debriefing after a simulation session improves the debriefing satisfaction and the perceived debriefing assessment among nursing students. [J Nurs Educ. 2021;60(2):90-95.].

A Creative Teaching Method for Research and Evidence-Based Practice

ABSTRACT

With nursing students placed in busy clinical environments where evidence-based practice (EBP) and research are often not considered a priority, teaching EBP to nursing students can be challenging. Innovation is required to ensure that nursing students not only recognize the importance of EBP but are also equipped with the knowledge, skills, and attitudes required to promote and implement EBP. This article describes the implementation of a video project as part of the EBP and research module. Feedback from students was positive, and the project has now been formally introduced into the curriculum.

Video-assisted debriefing technique for nursing simulation: how to proceed?

OBJECTIVE

To identify elements in scientific literature that make the video-assisted debriefing technique feasible in the teaching and learning process, in nursing simulation.

METHOD

Integrative literature review, conducted from May to July of 2019. Primary studies, with no time frame, were selected in Portuguese, English or Spanish, in the PubMed®, Scopus®, CINAHL and LILACS databases, using the Rayyan application. Qualitative analysis was adopted.

RESULTS

205 studies were initially identified, six of which were selected and categorized into: "Elements that make up the video-assisted debriefing technique"; "Benefits of using the video-assisted debriefing technique" and "Challenges of using the video-assisted debriefing technique".

CONCLUSIONS

The elements that made the video-assisted debriefing technique feasible in the teaching and learning process in nursing were concept, objectives, material resources and procedure. The main benefit was the immediate recognition of behaviors, and the challenge was the risk that the video would make debriefing tiring and humiliating.

Comparison of oral health behaviour between dental and non-dental undergraduates in a university in southwestern China--exploring the future priority for oral health education

Background

Based on a national survey in 2015, people’s oral health behaviour (OHB) has not kept up with the pace of knowledge and attitudes in China after decades of oral health education (OHE). Thus, we need to improve OHE to strengthen people’s OHB. Undergraduates are regarded as the best candidates for the improvement of OHE. The objective of this study is to determine undergraduates’ oral health status and existing problems in OHB by comparing dental and non-dental students at Sichuan University. We hope to provide some suggestions for future OHE to improve people’s OHB.

Methods

A quasi-experimental study designed with a pre-test and post-test group was conducted. A total of 217 dental students and 135 non-dental students were enrolled. They were administered an OHE course focused on OHB. A survey about oral health behaviour and knowledge was conducted before and after the course.

Results

According to the pre-course survey, dental students surpassed non-dental students in terms of toothbrushing frequency, method, and time, but unfortunately, flossing was overlooked by all the students. After the course, both dental and non-dental students showed strong willingness to improve their OHB. More non-dental students than dental students were willing to use toothpicks and Chinese herbal toothpaste before and after the course.

Conclusions

OHE focused on behaviour has a positive effect on university students. Future OHE and interventions should focus on flossing, toothbrushing methods, toothpicks, Chinese herbal toothpaste and modifications to adopt new media.

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.

Effects of live and video simulation on clinical reasoning performance and reflection

Introduction

In recent years, researchers have recognized the need to examine the relative effectiveness of different simulation approaches and the experiences of physicians operating within such environments. The current study experimentally examined the reflective judgments, cognitive processing, and clinical reasoning performance of physicians across live and video simulation environments.

Methods

Thirty-eight physicians were randomly assigned to a live scenario or video case condition. Both conditions encompassed two components: (a) patient encounter and (b) video reflection activity. Following the condition-specific patient encounter (i.e., live scenario or video), the participants completed a Post Encounter Form (PEF), microanalytic questions, and a mental effort question. Participants were then instructed to re-watch the video (i.e., video condition) or a video recording of their live patient encounter (i.e., live scenario) while thinking aloud about how they came to the diagnosis and management plan.

Results

Although significant differences did not emerge across all measures, physicians in the live scenario condition exhibited superior performance in clinical reasoning (i.e., PEF) and a distinct profile of reflective judgments and cognitive processing. Generally, the live condition participants focused more attention on aspects of the clinical reasoning process and demonstrated higher level cognitive processing than the video group.

Conclusions

The current study sheds light on the differential effects of live scenario and video simulation approaches. Physicians who engaged in live scenario simulations outperformed and showed a distinct pattern of cognitive reactions and judgments compared to physicians who practiced their clinical reasoning via video simulation. Additionally, the current study points to the potential advantages of video self-reflection following live scenarios while also shedding some light on the debate regarding whether video-guided reflection, specifically, is advantageous. The utility of context-specific, micro-level assessments that incorporate multiple methods as physicians complete different parts of clinical tasks is also discussed.

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.

Into the black-box of learning in simulation debriefing: A qualitative research study

BACKGROUND

Simulated learning activities are on the rise worldwide. Debriefing is viewed as a central element in simulated learning to enhance learning. Still, the question of how students learn in debriefing is underexplored.

AIM, DESIGN AND METHOD

The paper offers a contribution to the academy to better understand debriefing by presenting an in-depth, qualitative analysis of the practice of debriefing, carried out with 40 first-year nursing students (n = 40) in relation to roleplay simulation, training in clinical decision-making and patient involvement. The simulation sessions were carried out at a university hospital in Copenhagen, Denmark during clinical practice periods.

FINDINGS

Using theoretical conceptualizations from learning theorist Knud Illeris as sensitizing concepts, the paper points to the emergence of intended as well as unintended learning processes. In addition, it highlights the importance of focusing on facilitators' empowering as well as disempowering impact on students' motivation to engage in debriefing learning processes. An important finding is that the curricular overload leads to a prioritization of learning outcome related to natural science at the expense of "softer" competencies, e.g. patient involvement. The analysis also finds that students' motivation to process their real-life clinical experiences tends to be neglected. The conclusion thus points to a profound dilemma, unidentified in the literature, of learning ambitions in debriefing: the tension between attaining the formal learning objective and thus facilitating a tightly structured and focused debriefing on the one side, and the wish to develop critical and independent thinking on the other.

The impact of debriefing modalities on nurse practitioner students' knowledge and leadership skills in managing fatal dysrhythmias: A pilot study

Acute care nurse practitioners (ACNPs) require special training and educational preparation to meet their role expectations. Using high fidelity simulation with debriefing modalities is considered one of the innovative learning strategies in graduate nursing. No studies have investigated debriefing modalities in nurse practitioner programs specially ACNPs leadership skills. The purpose of this study was to examine the difference in students' knowledge, code team leader skills and self-efficacy using two debriefing modalities. A two group, pretest-posttest quasi-experimental design was used. Students were divided into video-assisted debriefing group vs. verbal debriefing following a simulation scenario of managing emergency codes. There were no significant differences between the two groups in knowledge acquisition/retention, leadership skills, and self-efficacy, but there was a significant difference in self-efficacy in both groups between two-time points. There was a general improvement in teams' performance. Students preferred verbal debriefing over video-assisted debriefing. The debriefing session plays an important role in graduate nursing education. Acute care nurse practitioners are lacking a formal leadership training to meet their advanced role. Nurse Educators, and simulation/debriefing leaders may benefit from our study results to develop a structured, formal curriculum and educational instruction focusing on acute care nurse practitioners' role change especially leading a resuscitation team.

Learning Impacts of Pretraining Video-Assisted Debriefing With Simulated Errors or Trainees' Errors in Medical Students in Basic Life Support Training: A Randomized Controlled Trial

BACKGROUND

Previous studies demonstrated that pretraining video-assisted debriefing (VAD) with trainees' errors (TE) videotaped in a skills pretest improved skill learning of basic life support (BLS). However, conducting a pretest and preparing TE video examples is resource intensive. Exposing individual trainee's errors to peers might be a threat to learners' psychological safety. We hypothesized pretraining VAD with simulated errors (SE, performed by actors) might have the same beneficial effect on skills learning as pretraining VAD with TE, but avoid drawbacks of TE.

METHODS

Three hundred twenty-two third-year medical students were randomized into 3 groups (the control [C], TE, SE). A videotaped BLS skills pretest was conducted in 3 groups. Then, group C received traditional training with concurrent feedback. Video-assisted debriefing with TE in the pretest or SE was delivered in groups TE or SE, respectively, followed by BLS training without any feedback. Basic life support skills were retested 1 week later (posttest). Students completed a survey to express their preference to TE or SE for VAD in the future.

RESULTS

Higher BLS skills scores were observed in groups TE (85.7 ± 7.0) and SE (86.8 ± 7.5) in the posttest, compared with group C (68.7 ± 13.3, P < 0.001). No skills difference was observed between group TE and SE in the posttest. More trainees (65.8%) preferred SE for VAD.

CONCLUSIONS

Pretraining VAD with SE had an equivalent beneficial effect as VAD with TE on BLS skills learning in medical students. More trainees preferred SE for VAD with regard to psychological safety.