Identifying Learning Acquired During Debriefing

180 Pages·2017·1.2 MB·English

by  Shelly J. Reed

UNLV Theses, Dissertations, Professional Papers, and Capstones
May 2016
Identifying Learning Acquired During Debriefing
Shelly J. Reed
University of Nevada, Las Vegas, [email protected]
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IDENTIFYING LEARNING ACQUIRED DURING DEBRIEFING

by

Shelly Jensen Reed

Bachelor of Science
Brigham Young University
1984

Master of Science – Nursing
University of Utah
1992

Doctorate of Nursing Practice
Case Western Reserve University
2007

A dissertation submitted in partial fulfillment
of the requirements for the

Doctor of Philosophy in Nursing

School of Nursing
Division of Health Sciences
The Graduate College

University of Nevada, Las Vegas
May 2016
Copyright by Shelly Jensen Reed, 2016
All Rights Reserved
Dissertation Approval
The Graduate College
The University of Nevada, Las Vegas

March 29, 2016
This dissertation prepared by
Shelly Jensen Reed
entitled
Identifying Learning Acquired During Debriefing
is approved in partial fulfillment of the requirements for the degree of
Doctor of Philosophy -Nursing
School of Nursing

Nancy Menzel, Ph.D. Kathryn Hausbeck Korgan, Ph.D.
Examination Committee Chair Graduate College Interim Dean

Michele Clark, Ph.D.
Examination Committee Member

Jessica Doolen, Ph.D.
Examination Committee Member

Ramona Denby-Brinson, Ph.D.
Graduate College Faculty Representative

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Abstract
Debriefing, the reflective activity following an experiential learning exercise, has been
identified as the most important part of simulation learning and is also important for learning in
other activities utilized in nursing education. There is general agreement that debriefing provides
learning and improves performance. However, there is little specific evidence about the
phenomenon of learning acquired during debriefing, including how it occurs, how it is defined
and identified, and how it is evaluated by debriefing facilitators. In addition, there are no
instruments or tools specifically measuring learning acquired during debriefing. Without
practical and theoretically grounded tools, simulation activities will continue to lack the element
of objective assessment necessary to move evidence-based teaching practices forward. A
measure of learning acquired during debriefing, independent of a specific debriefing method and
across debriefing types, will aid in the design of future simulation debriefing research that is both
rigorous and feasible.
To inform future tool development, I conducted a qualitative descriptive study to provide
initial evidence regarding the learning acquired during debriefing. Following Institutional
Review Board approval, I conducted 17 semi-structured interviews of nurse educators who
facilitate debriefing in pre-licensure nursing programs. The interviews were transcribed and data
analysis was completed to provide answers to the research questions using simple descriptive
statistics, inductive reasoning processes and content analysis to interpret and structure meaning
from the interviews.
Study results included the nurse educators’ verbatim definitions of learning as well as
simple descriptions of how they measured the learning acquired during debriefing. Qualitative
themes emerging from the interviews describe how nurse educators recognize when students are
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learning during debriefing; these themes also describe activities that the nurse educators used to
promote student learning during debriefing.
Nurse educators identified that nursing students are learning during debriefing when they
express what they have learned directly, connect past and present learning, plan for future
practice experiences, share with peers, experience the “Ah-ha” moment, critically review their
actions, display excitement and engagement during debriefing, apply their simulation learning in
subsequent clinical and simulation experiences, and display learning in formal and informal
assessments.
Nurse educators described many activities they used to promote learning when they
facilitated debriefings. These activities included utilizing simulation preparation activities,
aligning their debriefing practices with a specific debriefing method or learning theory, utilizing
intentional debriefing, establishing safety, maintaining a supportive demeanor, encouraging
student-led debriefing, engaging the student learner, using debriefing aids, promoting recognition
of learning, facilitating to the level of the learner, attending to the debriefing environment, and
providing post-debriefing activities.
I will use the results of this study to inform future development of an instrument intended
to measure learning acquired during debriefing. This study also provides many insights into how
nurse educators can facilitate learning during debriefing for pre-licensure nursing students.

iv
Acknowledgements
Thank you to my children for supporting me and for doing without a mom so many times
during these studies and to great friends that have also helped me along, especially my good
friend Deanna.
Thank you to a wonderful committee, Dr. Nancy Menzel, Dr. Michele Clark, Dr. Jessica
Doolen, and Dr. Ramona Denby, for your time, tutoring, talents, and especially teaching—I have
learned a lot from you throughout this experience and will be forever grateful.
Especially, a huge hug and thank you to my supportive and wonderful husband, Mike,
who always wants me to be the best I can be. I wouldn’t be where I am without you. You can
have me back now!

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List of Tables
Table 1. Terms and Definitions Related to Debriefing ............................................................. 6
Table 2. Participant demographic information. N=17 ........................................................... 44
Table 3. Comparison of Learning Items from the DES© with Study Themes.................... 114
Table 4. INACSL Standard VI: The Debriefing Process ..................................................... 119
Table 5. Facilitator Definitions of Learning .......................................................................... 121

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Table of Contents
Abstract ......................................................................................................................................... iii
Acknowledgements ....................................................................................................................... v
List of Tables ................................................................................................................................ vi
CHAPTER I .................................................................................................................................. 1
INTRODUCTION......................................................................................................................... 1
Background of the study .......................................................................................................... 1
Problem Statement ................................................................................................................... 2
Significance of Study............................................................................................................... 2
Purpose of Study ...................................................................................................................... 3
Conceptual Framework ............................................................................................................ 3
Study Aim and Research Questions ........................................................................................ 5
Definition of Terms ................................................................................................................. 5
Chapter Summary ......................................................................................................................7
CHAPTER II ................................................................................................................................. 8
REVIEW OF THE LITERATURE ............................................................................................ 8
Simulation Learning ................................................................................................................ 8
Simulation Debriefing and Learning ..................................................................................... 15
Chapter Summary ....................................................................................................................28
CHAPTER III ............................................................................................................................. 31
METHODS .................................................................................................................................. 31
Interpretive Science as the Epistemological Paradigm of Choice ......................................... 31
Qualitative Description as a Method Choice ......................................................................... 32
The Praxis Perspective of the Researcher .............................................................................. 33
Conducting the Interviews ..................................................................................................... 34
Data Collection ...................................................................................................................... 34
Data Analysis ......................................................................................................................... 38
Establishing Trustworthiness ................................................................................................. 39
Transferability ....................................................................................................................... 41
Dependability......................................................................................................................... 41
Confirmability ....................................................................................................................... 41
Chapter Summary ....................................................................................................................42
CHAPTER IV.............................................................................................................................. 43
FINDINGS ................................................................................................................................... 43
Demographic Findings .............................................................................................................43
QUALITATIVE FINDINGS ..................................................................................................... 45
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Defining Learning ....................................................................................................................45
Promoting Learning .................................................................................................................45
Utilizing Simulation Preparation Activities .......................................................................... 46
Identifying with a Specific Debriefing Method or Learning Theory .................................... 47
Intentional Debriefing ............................................................................................................ 49
Establishing Safety ................................................................................................................ 50
Facilitator Demeanor ............................................................................................................. 52
Encouraging Student-Led Debriefing .................................................................................... 53
Engaging the Student Learner ............................................................................................... 56
Using Debriefing Aids ........................................................................................................... 60
Promoting Recognition of Learning ...................................................................................... 65
Facilitating to the Level of the Learner ................................................................................. 70
Debriefing Environment ........................................................................................................ 72
Post-debriefing Activities ...................................................................................................... 74
Recognizing Learning ..............................................................................................................75
Direct Expressions of Learning ............................................................................................. 76
Connecting Learning ............................................................................................................. 77
Planning for Future Practice Experiences ............................................................................. 79
Sharing with Peers ................................................................................................................. 80
The “Ah-ha” Moment ............................................................................................................ 82
Critically Reviewing Actions ................................................................................................ 83
Excitement and Engagement during Debriefing ................................................................... 86
Application of Learning in Clinical and Simulation Experiences ......................................... 87
Formal and Informal Learning Assessments ......................................................................... 89
Measuring Learning ................................................................................................................89
Chapter Summary ....................................................................................................................92
CHAPTER V ............................................................................................................................... 93
CONCLUSIONS AND IMPLICATIONS ................................................................................ 93
Restatement of Research Questions ...................................................................................... 93
Summary of Qualitative Descriptive Research and Kolb’s Experiential Learning Theory .. 93
Discussion of Results............................................................................................................. 94
Question 1: How do debriefing facilitators define learning within the context of simulation
debriefing? ............................................................................................................................. 95
Question 2. How do debriefing facilitators promote student learning during debriefing? .... 96
Question 3. What do debriefing facilitators feel the student attitudes, behaviors, and
verbalizations are that indicate that learning has taken place during debriefing? ............... 113
Question 4. How do debriefing facilitators determine what has been learned during
debriefing? ........................................................................................................................... 114
Study Limitations ................................................................................................................ 115
Implications for practice ...................................................................................................... 116
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