Sissel Eikeland Husebø

The Relationship Between Facilitators' Questions and the Level of Reflection in Postsimulation Debriefing

Introduction Simulation-based education is a learner-active method that may enhance teamwork skills such as leadership and communication. The importance of postsimulation debriefing to promote reflection is well accepted, but many questions concerning whether and how faculty promote reflection remain largely unanswered in the research literature. The aim of this study was therefore to explore the depth of reflection expressed in questions by facilitators and responses from nursing students during postsimulation debriefings. Methods Eighty-one nursing students and 4 facilitators participated. The data were collected in February and March 2008, the analysis being conducted on 24 video-recorded debriefings from simulated resuscitation teamwork involving nursing students only. Using Gibbs’ reflective cycle, we graded the facilitators’ questions and nursing students’ responses into stages of reflection and then correlated these. Results Facilitators asked most evaluative and fewest emotional questions, whereas nursing students answered most evaluative and analytic responses and fewest emotional responses. The greatest difference between facilitators and nursing students was in the analytic stage. Only 23 (20%) of 117 questions asked by the facilitators were analytic, whereas 45 (35%) of 130 students’ responses were rated as analytic. Nevertheless, the facilitators’ descriptive questions also elicited student responses in other stages such as evaluative and analytic responses. Conclusion We found that postsimulation debriefings provide students with the opportunity to reflect on their simulation experience. Still, if the debriefing is going to pave the way for student reflection, it is necessary to work further on structuring the debriefing to facilitate deeper reflection. Furthermore, it is important that facilitators consider what kind of questions they ask to promote reflection. We think future research on debriefing should focus on developing an analytical framework for grading reflective questions. Such research will inform and support facilitators in devising strategies for the promotion of learning through reflection in postsimulation debriefings.

Creating Simulation Communities of Practice: An International Perspective

&NA; A three‐year National League for Nursing grant aimed at faculty development in the use of simulation as a teaching‐learning strategy to promote and evaluate student learning outcomes was funded in 2007 by the Laerdal Medical Corporation. The focus of the faculty development project was the creation of nine web‐based courses written by nine United States authors with the assistance of eight contributing partners from seven different countries. The process is described from the view of the international participants who worked together with the US experts. The significance of the work, the process, the challenges and barriers, and the benefits and rewards of the work are described. Recommendations for working on a multisite, international collaborative project are also discussed.

Simulation in Nursing Education—International Perspectives and Contemporary Scope of Practice

Purpose This article provides insights and perspectives from four experienced educators about their approaches to developing, delivering, and evaluating impactful simulation learning experiences for undergraduate nurses. A case study format has been used to illustrate the commonalities and differences of where simulation has been positioned within curricula, with examples of specialized clinical domains and others with a more generic focus. The importance of pedagogy in developing and delivering simulations is highlighted in each case study. A range of learning theories appropriate for healthcare simulations are a reminder of the commonalities across theories and that no one theory can account for the engaging and impactful learning that simulation elicits. Clinical Relevance Creating meaningful and robust learning experiences through simulation can benefit students’ performance in subsequent clinical practice. The ability to rehearse particular clinical scenarios, which may be difficult to otherwise achieve, assists students in anticipating likely patient trajectories and understanding how to respond to patients, relatives, and others in the healthcare team.

Educating for teamwork--nursing students' coordination in simulated cardiac arrest situations.

AIM The overarching aim was to explore and describe the communicative modes students employ to coordinate the team in a simulation-based environment designed for resuscitation team training. BACKGROUND Verbal communication is often considered essential for effective coordination in resuscitation teams and enhancing patient safety. Although simulation is a promising method for improving coordination skills, previous studies have overlooked the necessity of addressing the multifaceted interplay between verbal and non-verbal forms of communication. METHOD Eighty-one nursing students participated in the study. The data were collected in February and March, 2008. Video recordings from 28 simulated cardiac arrest situations in a nursing programme were analysed. Firstly, all communicative actions were coded and quantified according to content analysis. Secondly, interaction analysis was performed to capture the significance of verbal and non-verbal communication, respectively, in the moment-to-moment coordination of the team. FINDINGS Three phases of coordination in the resuscitation team were identified: Stating unconsciousness, Preparing for resuscitation, Initiating resuscitation. Coordination of joint assessments and actions in these phases involved a broad range of verbal and non-verbal communication modes that were necessary for achieving mutual understandings of how to continue to the next step in the algorithm. This was accomplished through a complex interplay of taking position, pointing and through verbal statements and directives. CONCLUSION Simulation-based environments offer a promising solution in nursing education for training the coordination necessary in resuscitation teams as they give the opportunity to practice the complex interplay of verbal and non-verbal communication modes that would otherwise not be possible.

A comparative study of defibrillation and cardiopulmonary resuscitation performance during simulated cardiac arrest in nursing student teams

BackgroundAlthough nurses must be able to respond quickly and effectively to cardiac arrest, numerous studies have demonstrated poor performance. Simulation is a promising learning tool for resuscitation team training but there are few studies that examine simulation for training defibrillation and cardiopulmonary resuscitation (D-CPR) in teams from the nursing education perspective. The aim of this study was to investigate the extent to which nursing student teams follow the D-CPR-algorithm in a simulated cardiac arrest, and if observing a simulated cardiac arrest scenario and participating in the post simulation debriefing would improve team performance.MethodsWe studied video-recorded simulations of D-CPR performance in 28 nursing student teams. Besides describing the overall performance of D-CPR, we compared D-CPR performance in two groups. Group A (n = 14) performed D-CPR in a simulated cardiac arrest scenario, while Group B (n = 14) performed D-CPR after first observing performance of Group A and participating in the debriefing. We developed a D-CPR checklist to assess team performance.ResultsOverall there were large variations in how accurately the nursing student teams performed the specific parts of the D-CPR algorithm. While few teams performed opening the airways and examination of breathing correctly, all teams used a 30:2 compression: ventilation ratio.We found no difference between Group A and Group B in D-CPR performance, either in regard to total points on the check list or to time variables.ConclusionWe found that none of the nursing student teams achieved top scores on the D-CPR-checklist. Observing the training of other teams did not increase subsequent performance. We think all this indicates that more time must be assigned for repetitive practice and reflection. Moreover, the most important aspects of D-CPR, such as early defibrillation and hands-off time in relation to shock, must be highlighted in team-training of nursing students.

Cross-cultural validation and psychometric testing of the Norwegian version of the TeamSTEPPS® teamwork perceptions questionnaire

BackgroundTeamwork is an integrated part of today’s specialized and complex healthcare and essential to patient safety, and is considered as a core competency to improve twenty-first century healthcare. Teamwork measurements and evaluations show promising results to promote good team performance, and are recommended for identifying areas for improvement. The validated TeamSTEPPS® Teamwork Perception Questionnaire (T-TPQ) was found suitable for cross-cultural validation and testing in a Norwegian context. T-TPQ is a self-report survey that examines five dimensions of perception of teamwork within healthcare settings. The aim of the study was to translate and cross-validate the T-TPQ into Norwegian, and test the questionnaire for psychometric properties among healthcare personnel.MethodsThe T-TPQ was translated and adapted to a Norwegian context according to a model of a back-translation process. A total of 247 healthcare personnel representing different professionals and hospital settings responded to the questionnaire. A confirmatory factor analysis was carried out to test the factor structure. Cronbach’s alpha was used to establish internal consistency, and an Intraclass Correlation Coefficient was used to assess the test - retest reliability.ResultA confirmatory factor analysis showed an acceptable fitting model (χ2 (df) 969.46 (546), p < 0.001, Root Mean Square Error of Approximation (RMSEA) = 0.056, Tucker-Lewis Index (TLI) = 0.88, Comparative fit index (CFI) = 0.89, which indicates that each set of the items that was supposed to accompany each teamwork dimension clearly represents that specific construct. The Cronbach’s alpha demonstrated acceptable values on the five subscales (0.786–0.844), and test-retest showed a reliability parameter, with Intraclass Correlation Coefficient scores from 0.672 to 0.852.ConclusionThe Norwegian version of T-TPQ was considered to be acceptable regarding the validity and reliability for measuring Norwegian individual healthcare personnel’s perception of group level teamwork within their unit. However, it needs to be further tested, preferably in a larger sample and in different clinical settings.

Norwegian nursing students’ evaluation of vSim® for Nursing

BackgroundvSim® for Nursing is the first web-based platform linked to the nursing education curriculum. It is an American simulation tool, developed in 2014 through a collaboration between Wolters Kluwer Health, Laerdal Medical and the National League for Nursing. To our knowledge, no studies have evaluated vSim® for Nursing from the nursing students’ perspective in Norway. The aim of the study was to evaluate second year Norwegian nursing students’ experiences with the virtual clinical simulation scenario in surgical nursing from vSim® for Nursing.MethodsA descriptive and a convergent mixed method design was utilised. The method comprised a 7-item questionnaire with five open-ended questions. Sixty-five nursing students participated in the study.ResultsThe majority of Norwegian nursing students evaluated the virtual clinical scenario in surgical nursing from vSim® for Nursing useful, realistic and educational in preparing for clinical placement in surgical care. However, a small portion of the nursing students had trouble understanding and navigating the American vSim® for Nursing program.ConclusionsIntroducing virtual simulation tools into the nursing education encompasses faculty and student preparation, guidance from faculty members during the simulation session and support for students who are facing difficulties with the simulation program.

Status of Nordic research on simulation-based learning in healthcare: an integrative review

BackgroundBased on common geography, sociopolitics, epidemiology, and healthcare services, the Nordic countries could benefit from increased collaboration and uniformity in the development of simulation-based learning (SBL). To date, only a limited overview exists on the Nordic research literature on SBL and its progress in healthcare education. Therefore, the aim of this study is to fill that gap and suggest directions for future research.MethodsAn integrative review design was used. A search was conducted for relevant research published during the period spanning from 1966 to June 2016. Thirty-seven studies met the inclusion criteria. All included studies were appraised for quality and were analyzed using thematic analysis.ResultsThe Nordic research literature on SBL in healthcare revealed that Finland has published the greatest number of qualitative studies, and only Sweden and Norway have published randomized control trials. The studies included interprofessional or uniprofessional teams of healthcare professionals and students. An assessment of the research design revealed that most studies used a qualitative or a descriptive design. The five themes that emerged from the thematic analysis comprised technical skills, non-technical skills, user experience, educational aspects, and patient safety.ConclusionThis review has identified the research relating to the progress of SBL in the Nordic countries. Most Nordic research on SBL employs a qualitative or a descriptive design. Shortcomings in simulation research in the Nordic countries include a lack of well-designed randomized control trials or robust evidence that supports simulation as an effective educational method. In addition, there is also a shortage of studies focusing on patient safety, the primary care setting, or a combination of specialized and primary care settings. Suggested directions for future research include strengthening the design and methodology of SBL studies, incorporating a cross-country comparison of studies using simulation in the Nordic countries, and studies combining specialized and primary care settings.

Gastric bypass - ingen snarvei til ny livsstil. Pasienterfaringer to år etter kirurgi

The aim of the study was to examine which factors affect the patients ability to cope with lifestyle changes, the importance of social support to maintain lifestyle changes and how patients experience follow-up from healthcare professionals, two years after surgery. A qualitative exploratory design was chosen. Three focus group interviews were conducted with 13 patients. Content analysis was used to analyse the interviews. The findings revealed three themes; from knowledge to action, the importance of social support, and insufficient follow-up from the healthcare service. T he patients need structure in everyday life, self-discipline and social support to reinforce self-efficacy and to manage and maintain lifestyle changes. Information and support from healthcare professionals should be tailored to where the patient is in the change process.