Debriefing with Reflection: Best Practice for Learning in Simulation in Pre-Licensure Nursing Education
Date of Award
DNP Doctor of Nursing Practice
Mary Ellen Roberts, D.N.P.
Maureen Byrnes, D.N.P.
Donnean Thrall, D.N.S.
Purpose: The purpose of this project was intended to transform the outdated method of conducting debrief after simulation by implementing a good judgment model and integrating the concept of “advocacy-inquiry.” This implementation was expected to reduce demoralizing and anxiety producing debrief experiences and improve student reflection and learning in order for students to more deliberately link theory with practice.
Significance: The debrief is often recognized as the component of simulation in which the most effective learning occurs. It is the time when students are provided opportunity to reflect on thoughts, actions and behaviors. Unfortunately, many nursing students often experience undue stress during simulation resulting in limited comprehension of how they did or did not meet outcomes. Students have expressed feeling judged during simulation thus; making it difficult to allow themselves to feel vulnerable enough to fully reflect on why they made mistakes.
Methods: Realizing that a caring supportive model may improve student engagement and critical thinking Jean Watson’s Theory of Human Caring was recognized as a solid foundation in which to build this initiative. Utilizing best practices set forth by the Center for Medical Simulation (CMS) and INACSL (The International Nursing Association for Clinical Simulation and Learning) several new concepts and tools have been integrated into the simulation debriefing process. Importantly, faculty have been provided training in methods in which to successfully debrief so students are able to reflect on the simulation experience. The “debriefing with good judgment” model (Rudolph, Simon, Dufresne & Raemer, 2006) as well as the method of debriefing using “advocacy-inquiry” (Rudolph, Simon, Rivard, Dufresne, Raemer, 2007) are two such tools which guided the faculty to ensure a consistent reflection process. This process assisted students in recognizing and resolving clinical dilemmas identified during the simulation.
Findings: Of 125 students in the spring 2017 cohort the vast majority identified positive changes in the simulation experience. Several students commented on “improved learning and insight” as well as an appreciation for the “focus on reflection.” Students also recognized that simulations were now “less judgmental than previous simulations” affirming the importance of integrating the “debriefing with good judgment” model (Rudolph, et al, 2006). The faculty identified that integrating the good judgment model and advocacy-inquiry tool into the debrief did result in improved student engagement. Overall students appeared to be less anxious and more reflective during the debrief process.
Conclusion: This initiative proved to be a successful intervention in increasing student reflection and participant satisfaction. This paper will discuss the successful transformation of the simulation debriefing process at one academic institution.
McDermott, Mary, "Debriefing with Reflection: Best Practice for Learning in Simulation in Pre-Licensure Nursing Education" (2017). Seton Hall University DNP Final Projects. 20.