An Evaluation of Simulation Debriefings on Student Nurses’ Perceptions of Clinical Reasoning and Learning Transfer: A Mixed Methods Study

Sandra Johnston; Robyn Nash; Fiona Coyer

doi:10.1515/ijnes-2018-0045

Article

An Evaluation of Simulation Debriefings on Student Nurses’ Perceptions of Clinical Reasoning and Learning Transfer: A Mixed Methods Study

Sandra Johnston , Robyn Nash and Fiona Coyer

Published/Copyright: March 12, 2019

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From the journal International Journal of Nursing Education Scholarship Volume 16 Issue 1

Abstract

To aim of this study was to explore undergraduate nursing student (n = 256) perceptions of clinical reasoning ability and learning transfer after participating in either a standard post simulation debriefing or a debriefing based on transfer of learning principles. Background: It is assumed that students will transfer what they have learned from simulation to real world practice, however, some students are unable to identify the relevance of simulated learning experiences if scenarios are dissimilar to clinical placement settings. The nature and extent what is able to be transferred from simulated to real settings is unclear, particularly in relation to complex processes such as clinical reasoning. Transfer of learning to a new situation involves deliberate cognitive effort, including reflection and mindful abstraction of central attributes of a problem. As reflection is a key element in learning transfer, the debriefing element of simulation was seen to be a platform for this study. Method: A convergent parallel mixed methods design used a pre-test, post-test survey and focus group interviews. Results: No statistically significant difference in post-test clinical reasoning scores between groups was found. There was a statistically significant improvement in 12 out of 15 criteria among the control group and in 8 of the criteria among the intervention group. Qualitative findings provided some evidence that learning had transferred to clinical settings. Evidence of “near” transfer was more evident than “far” transfer. Conclusion: Positive findings included that all students perceived they had transferred the skills of patient assessment and effective communication during episodes of patient care. The concept of a “framework” being verbalized by many of the intervention group during practice is a promising finding and may be a useful direction for further research focusing on the instructional demonstration of explicitly promoting a level of abstraction of problems and prompting participants to search for conceptual connections. This may indicate retained idea or concepts from the debriefing which may be useful in future practice.

Keywords: debriefing; simulation; learning transfer; undergraduate nursing education

Correction note

Correction added after ahead-of-print publication on March 12, 2019: Two authors have been inadvertently left out from the list of authors. The author list has now been corrected to reflect all three authors.

References

Boese, T., Cato, M., Gonzalez, L., Jones, A., Kennedy, K., Reese, C., … Meakim, C. (2013). Standards of best practice: Simulation standard V: Facilitator. Clinical Simulation in Nursing, 9(6), S22–S25.10.1016/j.ecns.2013.04.010Search in Google Scholar

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.10.1191/1478088706qp063oaSearch in Google Scholar

Bryman, A., & Cramer, D. (2004). Quantitative data analysis with SPSS 12 and 13: A guide for social scientists. London: Routledge.10.4324/9780203498187Search in Google Scholar

Cormier, S., & Hagman, J. (2014). Transfer of learning contemporary research and applications. Saint Louis: Elsevier Science.Search in Google Scholar

Creswell, J. W., & Plano Clark, V. L. (2011). Designing and conducting mixed methods research (2nd ed.). Los Angeles: SAGE Publications.Search in Google Scholar

Dreifuerst, K. (2012). Using debriefing for meaningful learning to foster development of clinical reasoning in simulation. Journal of Nursing Education, 51(6), 326–333.10.3928/01484834-20120409-02Search in Google Scholar PubMed

Dreifuerst, K. T., & Decker, S. (2012). Debriefing: An essential component for learning in simulation pedagogy. In Simulation in nursing education: From conceptualization to evaluation (pp. 105–130). New York: National League for Nursing.Search in Google Scholar

Gegenfurtner, Andreas et al. (2013). Effects of Computer Support, Collaboration, and Time Lag on Performance Self-Efficacy and Transfer of Training: A Longitudinal Meta-Analysis. Educational Research Review, [Online] 8 (1), 75–89.10.1016/j.edurev.2012.04.001Search in Google Scholar

Haskell, R. E. (2001). Transfer of learning: Cognition, instruction, and reasoning. San Diego, CA: Academic Press.10.1016/B978-012330595-4/50003-2Search in Google Scholar

Hung, C. H., & Lin, C. Y. (2015). Using concept mapping to evaluate knowledge structure in problem-based learning. BMC Medical Education, 15(1), 212.10.1186/s12909-015-0496-xSearch in Google Scholar PubMed PubMed Central

INACSL Stand Comm. (2016). INACSL standards of best practice: Simulation(SM) simulation glossary. Clinical Simulation in Nursing, 12, S39–S47. doi:10.1016/j.ecns.2016.09.012Search in Google Scholar

Johnston, S., Coyer, F. & Nash, R (2017). Simulation debriefing based on principles of transfer of learning: A pilot study. Nurse Education in Practice, 26, 102–108.10.1016/j.nepr.2017.08.002Search in Google Scholar PubMed

Kirkman, T. (2013). High fidelity simulation effectiveness in nursing students’ transfer of learning. International Journal of Nursing Education Scholarship, 10, 171.10.1515/ijnes-2012-0009Search in Google Scholar PubMed

Kolb, A. Y., & Kolb, D. A. (2009). The learning way: Meta-cognitive aspects of experiential learning. Simulation & Gaming, 40(3), 297–327.10.1177/1046878108325713Search in Google Scholar

Lavoie, P., Pepin, J., & Cossette, S. (2015). Development of a post-simulation debriefing intervention to prepare nurses and nursing students to care for deteriorating patients. Nurse Education in Practice, 15(3), 181–191. doi:10.1016/j.nepr.2015.01.006Search in Google Scholar PubMed

Levett-Jones, T., & Bourgeois, S. (2015). The clinical placement-e-book: An essential guide for nursing students. Australia: Elsevier Health Sciences.Search in Google Scholar

Levett-Jones, T., Lapkin, S., Hoffman, K., Arthur, C., & Roche, J. (2011). Examining the impact of high and medium fidelity simulation experiences on nursing students’ knowledge acquisition. Nurse Education in Practice, 11(6), 380–383.10.1016/j.nepr.2011.03.014Search in Google Scholar PubMed

Liaw, S. Y., Chan, S. W. C., Scherpbier, A., Rethans, J. J., & Pua, G. G. (2012). Recognizing, responding to and reporting patient deterioration: Transferring simulation learning to patient care settings. Resuscitation, 83(3), 395–398.10.1016/j.resuscitation.2011.08.021Search in Google Scholar PubMed

Liou, S.-R., Liu, H. C., Tsai, H. M., Tsai, Y. H., Lin, Y. C., Chang, C. H., & Cheng, C. Y. (2016). The development and psychometric testing of a theory-based instrument to evaluate nurses’ perception of clinical reasoning competence. Journal of Advanced Nursing, 72(3), (0309–2402), 707.10.1111/jan.12831Search in Google Scholar PubMed

Miles, D. A. (2018). Simulation learning and transfer in undergraduate nursing education: A grounded theory study. Journal of Nursing Education, 57(6), 347–353. http://dx.doi.org.ezp01.library.qut.edu.au/10.3928/01484834-20180522-0510.3928/01484834-20180522-05Search in Google Scholar PubMed

Missen, K., McKenna, L., Beauchamp, A., & Larkins, J. A. (2016). Qualified nurses’ rate new nursing graduates as lacking skills in key clinical areas. Journal of Clinical Nursing, 25(15–16), 2134–2143. doi:10.1111/jocn.13316Search in Google Scholar PubMed

Nash, R., & Harvey, T. (2017). Student nurse perceptions regarding learning transfer following high-fidelity simulation. Clinical Simulation in Nursing, 13(10), 471–477. doi:10.1016/j.ecns.2017.05.010Search in Google Scholar

Pallant, J. (2016). SPSS survival manual: A step by step guide to data analysis using IBM SPSS (6th ed. ed.). Crows Nest: NSW: Allen & Unwin.Search in Google Scholar

Pendleton, D. (1984). The consultation:. an approach to learning and teaching: Oxford University Press.Search in Google Scholar

Salomon, G., & Perkins, D. N. (1989). Rocky roads to transfer: Rethinking mechanism of a neglected phenomenon. Educational Psychologist, 24(2), 113–142.10.1207/s15326985ep2402_1Search in Google Scholar

Sandroni, C., & Cavallaro, F. (2011). Failure of the afferent limb: A persistent problem in rapid response systems. Resuscitation, 82(7), 797–798.10.1016/j.resuscitation.2011.04.012Search in Google Scholar PubMed

Schneidereith, T. A. (2014). Using simulations to identify nursing student behaviors: A longitudinal study of medication administration. Journal of Nursing Education, 53(2), 89–92.10.3928/01484834-20140122-07Search in Google Scholar PubMed

Spillane, V., Byrne, M. C., Byrne, M., Leathem, C. S., O’Malley, M., & Cupples, M. E. (2007). Monitoring treatment fidelity in a randomized controlled trial of a complex intervention. Journal of Advanced Nursing, 60(3), 343–352.10.1111/j.1365-2648.2007.04386.xSearch in Google Scholar PubMed

Tavakol, M., & Dennick, R. (2011). Making sense of Cronbach’s alpha. International Journal of Medical Education, 2, 53–55. doi:10.5116/ijme.4dfb.8dfdSearch in Google Scholar PubMed PubMed Central

Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes. Oxford, UK: Harvard University Press.Search in Google Scholar

Received: 2018-07-29

Revised: 2019-02-11

Accepted: 2019-02-17

Published Online: 2019-03-12

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Articles in the same Issue

https://doi.org/10.1515/ijnes-2018-0045

Keywords for this article

debriefing; simulation; learning transfer; undergraduate nursing education