HealthMay 01, 2018

The 411 on debriefing in clinical simulation: How nursing simulations & debriefing create better nurses

As nurse educators make strides to promote higher-level reasoning skills, it's vital to understand how debriefing in clinical simulation plays a huge role in transitioning students into practicing nurses. In fact, the National League for Nursing (NLN) and the International Nursing Association for Clinical Simulation and Learning (INACSL) believe that integrating debriefing across the nursing curriculum - including in simulation - can transform nursing education.

Debriefing is an essential methodology that encourages students to “know what,” “know how,” and “know why.” It has been identified as an intentional and important phase for the consolidation and transfer of learning, and is the cornerstone of experiential learning in high-fidelity simulation. Sure, training specific skills is important, but it is solving complex scenarios in a simulated environment that truly strengthens nursing students” technical, relational, and ethical skills. Reflection is the core of debriefing, and is central to viewing patient scenarios with a crucial eye and assessing next steps. Nursing instructors don"t just want their students to memorize lessons and techniques; they want them to reflect on them, draw conclusions, and think of outside-the-box answers. And in clinical simulation, debriefing is a key part of this active learning environment. “It contributes to a more intense experience of clinical situations and improved use of cognitive, affective and psychomotor skills,” according to recent research.

The National Council of State Boards of Nursing (NCSBN) Simulation Study found that simulation can be safely substituted for traditional clinical placements, but one of the specific conditions was having “subject matter experts who conduct theory-based debriefing.” These experts - faculty, ideally - should be thoroughly trained, and faculty should be regularly assessed on their debriefing capabilities. Studies on simulation outcomes have found that students” experience increased satisfaction, knowledge, motivation, realism, self-confidence, technical skills, reflection-on-action, skills transfer, and cognitive and psychomotor development after using simulation to practice certain medical techniques. In addition, frequent simulation use helps students feel less afraid of performing the procedures directly on patients.

Research out of Australia identified eight themes and best practices that emerged from literature studies on best practices and guidelines for debriefing in simulation-based education:

  1. Types of debriefing (video assisted and facilitator only)
  2. Debrief in simulation versus postsimulation
  3. Environment in which the debrief takes place
  4. The person who should facilitate the debrief
  5. Assessment and training of the debriefer
  6. Identification of the learning outcomes
  7. Structure of the debrief
  8. Debrief method

“The integrative review strongly suggested that a safe, structured debrief following the simulation immersion is aligned to best practice,” the Australia researchers concluded. “Best practice in simulation is conducive to promoting clinical psychomotor skills and knowledge.”

Examples of debriefing in clinical simulation

Debriefing is a critical conversation that needs to occur between teacher and student to reframe the context of the situation and clarify perspectives and assumptions.

For example, after a group of nursing students participates in a simulation - either inside or outside of the sim lab - caring for patients exhibiting certain symptoms, the debriefer would go through a number of questions to help student discuss and recap their experience and what they learned.

Here are some debriefing and guided reflection questions debriefers at Indiana University's School of Nursing utilize for multiple-patient simulation experiences.

The importance of debriefing in clinical simulation [infographic]

Take these facts about debriefing in clinical simulation and its importance to nursing students” learning process into consideration:

  • Empirical studies have demonstrated that learning does not occur in simulation-based education in the absence of debriefing.
  • Poorly conducted debriefing results in persistent poor clinical judgment.
  • The quality of debriefing was positively correlated with improved learning outcomes.
  • Simulation plus theory-based, reflective debriefing led to a significant and measurable difference in nurse practitioners” critical thinking skills.
  • Using simulation plus theory-based debriefing allowed instructors to broaden the conversation beyond technical errors and influence learner reflection on professional development.
  • Student say structured debriefing minimizes their distress and insecurity, provides positive reinforcement, enables interactive practice and encourages students to repeat and participate in the activities.
  • Students say these debriefing exercises strengthen relationships between themselves and teachers/facilitators and teamwork skills.
  • Students feel as if their mistakes are not pointed out in a negative way; rather, they are comfortable asking questions and consider criticism during the debrief process as constructive and positive.

As you can see, debriefing is a critical component to successful simulations scenarios for your nursing students. So, as instructors, it's important to refine your debriefing skills in clinical simulation so that students may better understand what certain actions were taken and further, why they need to be taken. When you"re ready to implement theory-based, reflective debriefing in your curriculum, start with a simulation technology that fits your needs as well as your students".

Lippincott's vSim for Nursing can offer great simulation scenarios for nursing students to practice while you can focus on debriefing. vSim for Nursing, co-developed by Laerdal Medical and Wolters Kluwer, helps reinforce the lessons of high-fidelity patient simulators. It helps nursing students hone their prioritization and clinical reasoning and decision-making skills before they practice these skills in the sim lab. Courses include Fundamentals, Medical-Surgical, Maternity, Pediatric, Gerontology, Pharmacology, Health Assessment, and Mental Health. With 94% of nursing faculty agreeing that vSim accurately depicts clinical scenarios, it can absolutely provide your nursing students with the real-life simulations they need to feel more confident and prepared when dealing with real-life patient scenarios while on the job.

Want to find out more about how vSim for Nursing can train your students to be proficient nurses of the future? Let us know more about your program and we"ll get back to you!

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