Debriefing methods and learning outcomes in simulation nursing education: A systematic review and meta-analysis

doi:10.1016/j.nedt.2020.104345

Nurse Education Today

Volume 87, April 2020, 104345

https://doi.org/10.1016/j.nedt.2020.104345 Get rights and content

Abstract

Objectives

Simulation can serve as an effective educational method to provide experience and opportunities to learn about the nursing management of clinical cases in a secure environment. Numerous debriefing methods have been used in simulation in nurse education to improve clinical competencies and learning outcomes. However, there is insufficient evidence to identify the debriefing methods that are most effective in improving learning outcomes. In this systematic review and meta-analysis, the focus is on debriefing methods and learning outcomes in simulation in nurse education.

Design

This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement.

Data sources

Studies published from January 1995 to December 2016 were identified from PubMed, Embase, MEDLINE, PsycINFO, Web of Science, CINAHL, the Cochrane Library, and Korean databases.

Review methods

Experimental studies that used debriefing methods in simulation in nurse education were included as review studies. Studies that used identical validated measurement tools were included in the meta-analysis. We applied a random-effects model with subgroups. Effect sizes for learning outcomes according to debriefing methods were calculated using standardized mean differences.

Results

A total of 18 studies were selected through systematic review and 7 studies were included in the meta-analysis using four types of scales measuring learning outcomes after debriefing. The overall effect size of the learning outcomes, according to the type of debriefing method, was 0.31. The results regarding debriefing methods were statistically non-significant in the learning outcomes (95% CI [−0.33–0.96], Z = 0.95, p = 0.34). A symmetric shape indicated a lack of publication bias.

Conclusions

The study findings indicated that structured debriefing helped to improve learning. Future studies are needed to provide effective debriefing strategies with larger sample sizes.

Introduction

Healthcare environments have changed with technical improvements in diagnosis and care. This change has prolonged the lifespans of people with complex chronic diseases. Patient safety and increased attention to patients' rights have resulted in higher expectations of clinical performance in nurses (Lee and Hahn, 2011). Nurse educators should use a variety of educational methods to prepare nursing students with essential competencies (Wojnar and Whelan, 2017).

Simulation is an educational method that can be used in nursing to enable learners to experience and learn about nursing management of clinical cases in a more secure environment. For over a decade, nursing schools have provided simulations and interdisciplinary education to improve practical skills in healthcare providers (McGowan, 2008). There is increasing need for faculty who are proficient in simulation education methods (Pawl and Anderson, 2017). These proficient educators can promote the development of competencies such as critical thinking, decision-making, and therapeutic communication skills (Aggarwal et al., 2010; Pardue, 2015).

A simulation consists of a briefing, simulation conduct and a debriefing (Nyström et al., 2016). Specifically, the debriefing aims to foster learners' performance, ability to correct errors, clinical reasoning, and judgment skills (Dreifuerst, 2009; Fanning and Gaba, 2007; Simmons, 2010). The aim is to help bridge the gap between learning and experience through reflection and feedback (National League for Nursing, 2015). Currently, the debriefing methods used in simulation education vary widely across faculties and evidence indicating the most effective debriefing method remains insufficient. Recently, systematic reviews and meta-analytical studies of debriefing methods have emerged, emphasizing the importance of non-technical skills training for debriefing methods (Cheng et al., 2014; Garden et al., 2015; Levett-Jones and Lapkin, 2014; Waznonis, 2014). However, there is limited information on learning outcomes according to the simulation scenario or debriefing method (e.g., debriefing type, length, course operator) used in simulation in nurse education.

Section snippets

Background

While clinical competence is emphasized, the importance of simulations that can improve the practical clinical performance of learners is highlighted. Simulation is an education method that can strengthen the practical clinical competency of learners at various levels ranging from nursing students to health care workers (McGaghie et al., 2010; Saylor et al., 2016).

Kolb's experiential learning theory is one of the primary theoretical frameworks for debriefing in simulation (Fey et al., 2014;

Method

A systematic review and meta-analysis was conducted according to the systematic review guidelines and preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement by the Cochrane Collaboration (Higgins and Green, 2011). The purpose of the review was to verify the effects of debriefing methods on learning outcomes in simulation in nurse education. A quantitative approach was used to analyze the effectiveness of debriefing methods in improving nursing students' learning

Overall study findings of selected studies

Following the primary search, 1710 studies were identified via the aforementioned databases and reference lists; 723 studies remained after excluding redundant literature. After reviewing titles and abstracts, 129 studies met the inclusion criteria, though 111 of these articles were excluded on full text: 5 that included healthcare professionals such as surgeons and anesthetists, 4 that were considered review papers, 24 that were not found to be original articles, 27 that did not use an

Discussion

This systematic review and meta-analysis was conducted to determine the effectiveness of debriefing methods that can maximize learning outcomes in simulation nursing education, which makes the results of this study important.

Waznonis (2014) presented various debriefing methods in a review study, such as videos, scripts, worksheets, media (Internet chat, discussion boards, blogs, etc.), lectures, games, storytelling, peer feedback, educator feedback, multidisciplinary feedback, simulator log

Conclusion

Simulation education has been developed to improve nursing competency. Currently, the debriefing methods used in simulation nursing education are diverse, and evidence indicating the most effective debriefing method remains insufficient. The effective debriefing methods may vary depending on the learning outcomes, the target learner, and the context. Despite this, our study provides most effective debriefing methods as structured debriefing methods. Structured debriefings between learners and

Role of funding source

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contribution

(1)
The conception and design of the study, or acquisition of data, or analysis and interpretation of data: JuHee Lee, Hyejung Lee, Sue Kim, Mona Choi, Il Sun Ko, JuYeon Bae, Sung Hae Kim.
(2)
Drafting the article or revising it critically for important intellectual content: JuHee Lee, Hyejung Lee, Sue Kim, Mona Choi, Il Sun Ko, JuYeon Bae, Sung Hae Kim.
(3)
Final approval of the version to be submitted: JuHee Lee, Sung Hae Kim: JuHee Lee, Hyejung Lee, Sue Kim, Mona Choi, Il Sun Ko, JuYeon Bae, Sung Hae Kim.

Funding source

Not applicable.

Ethical approval

Not applicable.

Declaration of competing interest

Not applicable.

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ReviewDebriefing methods and learning outcomes in simulation nursing education: A systematic review and meta-analysis

Abstract

Objectives

Design

Data sources

Review methods

Results

Conclusions

Introduction

Section snippets

Background

Method

Overall study findings of selected studies

Discussion

Conclusion

Role of funding source

Authors' contribution

Funding source

Ethical approval

Declaration of competing interest

Clin. Simul. Nurs

Patient Educ. Couns.

Clin. Simul. Nurs

Clin. Simul. Nurs

Nurse Educ Pract

Clin. Simul. Nurs

Int. J. Nurs. Stud.

Nurse Educ. Today

Clin. Simul. Nurs

Nurs. Outlook

Clin. Simul. Nurs

Nurs. Outlook

Nurse Educ. Pract.

Clin. Simul. Nurs

Clin. Simul. Nurs

Clin. Simul. Nurs

Nurs. Outlook

Improving simulation performance through Self-Learning Methodology in Simulated Environments (MAES©)

Nurse Educ. Today

Training and simulation for patient safety

Qual. Saf. Health. Care

Introduction to Meta-Analysis

Debriefing for technology-enhanced simulation: a systematic review and meta-analysis

Med. Edue

Problem solving & Critical Thinking between Instructor and Senior Debriefing in Simulation Education for Nursing Students

AJMAHS

Clinical Practice and Debriefing Satisfaction after simulation debriefing with video

JKSSN

The essentials of debriefing in simulation learning: a concept analysis

Nurs. Educ. Perspect.

Using debriefing for meaningful learning to foster development of clinical reasoning in simulation

J. Nurs. Educ.

Structuring feedback and debriefing to achieve mastery learning goals

Acad. Med.

Review
Debriefing methods and learning outcomes in simulation nursing education: A systematic review and meta-analysis