The Current Practice of Nursing Clinical Simulation Debriefing: A Multiple Case Study

Experts have identified simulation debriefing as the crucial or pivotal point to learning (Baldwin, 2007; Gaba, Howard, Fish, Smith, & Sowb, 2001), and the “heart and soul” of simulation (Rall, Manser, & Howard, 2000, p. 517). No research studies exist that support how best to perform this crucial activity, particularly as it relates to nursing clinical simulation (NCS) debriefing.

My aim in this study was to explore and describe the current practice of NCS debriefing. I studied the phenomenon as it naturally occurred, a group exercise, and interaction between the educator, student, and environment. The research question was the following: How is NCS debriefing currently practiced?

No data exist regarding the proposed study; therefore, a purposive sample of four individual cases was proposed as an adequate number to acquire sufficient intercollegiate variation. I chose study sites from the three geographic locations of Tennessee: West, Middle, and East.

Creating individual case descriptions was the first analytical method used to begin cross case analysis. I then reduced the data using several techniques: categorical aggregation, time-ordered displays, content analysis, and pattern matching. Iterative comparison of data resulted in further reduction. The videotapes served as bases throughout the entire analytical process and were considered the primary source if any dispute or disagreement among sources occurred. After cases were analyzed individually, a cross case analysis revealed patterns or potential typologies of instructor participants. The final cross case synthesis of the emerged patterns produced seven patterns; four patterns matched those of the extant literature, (communication, time, structure, and emotion), and three new patterns emerged: accentuate the positive, higher order thinking, and experience counts.

Debriefing provides students the opportunity to reflect on their experiential learning exercises and to hypothesize how they might perform differently next time. Debriefing also offers students a reality check, a way to see themselves through the eyes of the teacher or their peers, something the participants in this study (i.e., students and educators) valued and sought.