• Clinical Simulation in Pre-Licensure Nursing Students: Improving Learning Outcomes in Psychologically Safe Learning Environments

      Daniels, Amy Louise; Johantgen, Mary E. (2018)
      Background: Simulation-based education in pre-licensure nursing programs is increasing exponentially as alternative clinical teaching experiences. Implementing quality simulation experiences is resource intensive, cost limiting, with limited evidence of the impact on learning outcomes. Standards of Best Practice: SimulationSM identify formal training is essential for quality debriefing, including providing a psychologically safe learning environment. However, a recent nationwide survey of 150 nursing schools identified only 40% of programs formally train simulation facilitators. In addition, there are limited valid and reliable instruments measuring reflective thinking as a learning outcome and debriefing competence. Purpose: The first paper reviewed literature on psychological safety in nursing pre-licensure simulation and assessed alignment with Edmondson's work-team learning model. A second paper described reflective thinking measured by the Reflective Thinking Questionnaire (RTQ), and explored RTQ scores in relation to facilitator training length and Debriefing Assessment for Simulation in Healthcare Student Version (DASH-SV)© scores. A third paper explored the psychometric qualities of the RTQ. Methods: Using a quasi-experimental, cross-sectional, nonequivalent, two-group design, pre-licensure nursing students were surveyed using the RTQ and the DASH-SV (N=99). The six facilitators had varied experience and training. Descriptive and bivariate analyses examined RTQ subscales in relation to student characteristics and DASH-SV© scores in relation to student and facilitator characteristics. MPLUS was used for CFA of the RTQ to explore how well a hypothesized model based on pre-licensure nursing students fit sample data. Results: Simulation-based nursing education literature demonstrates alignment with Edmondson's work-team learning model, although only 10 articles met inclusion criteria. RTQ subscale scores did not differ across differing facilitator characteristics. Students rated 1-day trained facilitators higher in establishing psychological safety and provoking in-depth discussions compared to 5-day trained facilitators. Confirmatory factor analysis of the RTQ supported the hypothesized model from the literature, although model fit remains inadequate. Conclusions: No associations were found between 1-day and 5-day facilitator training and student reflective thinking. Although a small single-site study with limited measures, nursing schools should require 1-day training at a minimum. It is imperative to conduct more rigorous simulation studies to establish efficacy of simulation as a training methodology, development conceptual frameworks, and improve measures.
    • Debriefing Practices in Nursing Education Programs in the United States

      Fey, Mary K.; Jenkins, Louise Sherman (2014)
      Debriefing is essential to learning in simulation based education. However, little is known about current debriefing practices. While there is no single theory of debriefing, consistent themes about the characteristics of debriefing emerge from the simulation literature. The purpose of this study was to describe debriefing practices in prelicensure nursing programs. Logistic regression analysis identified the characteristics of the nursing program and the simulation administrator that are associated with the use of theory based debriefing. A descriptive cross-sectional design was used. Data was collected via the internet. The study questionnaire consisted of three parts: demographic questions about the nursing program, questions about the simulation administrator, and questions about debriefing practices. The study sample comprised prelicensure nursing programs from across the United States representing all entry level degree programs (n = 502). Descriptive analyses showed that most programs have integrated simulation into their curriculum. Most schools designate a faculty member to have responsibility for simulation activities. The majority of debriefing facilitators have no training in debriefing. Less than 20% of all debriefers have their competence assessed. Debriefing is not usually guided by a theory or model. The majority of respondents (82%) reported debriefing practices that incorporated the concepts of Kolb's experiential learning theory. Further data analysis explored the relationships that significantly affected the use of theory based debriefing practices. The presence of a designated simulation administrator was significantly associated with the use of theory based debriefing. Simulation administrators who had formal training in simulation and who were in the 46-55 year old age group were significantly more likely to practice theory based debriefing. Training and competency assessment, along with structuring debriefing discussions were significantly associated with the use of theory based debriefing. Findings suggest that nursing programs should allocated resources to several aspects of the simulation program. Programs should have a designated simulation administrator. This person should have training in simulation based education. All faculty who facilitate debriefings should have training and should have their competence assessed regularly. This study provides information about debriefing practices; the study should be repeated with other types of learners (e.g. medical students, licensed practitioners).