Theses Doctoral

Prebriefing for Clinical Judgment in Nursing Simulation

Parker, Elizabeth

Simulation in nursing education has become a standard method of instruction to provide nursing students with a realistic and safe environment in which to practice and hone clinical skills. There are three components to a nursing simulation: prebriefing, the simulation experience, and debriefing. While there is a list of minimum criteria recommended for the prebriefing experience at the time of this dissertation there were no published frameworks or models for prebriefing.

A quasi-experimental pretest/posttest study assessed the impact of a structured prebriefing method on sophomore level nursing students’ (N = 55) clinical judgment, perception of their ability to care for patients, and their perceptions of the prebriefing and simulation experiences when compared to a group that was exposed to only the standard prebriefing criteria. All participants had the same simulation scenario. Participants were placed in groups of four then groups were randomly assigned to the structured prebriefing (intervention) or standard prebriefing (control). The instruments used in this study were the Satisfaction and Confidence in Learning Scale (SCLS), Prebriefing Experience Scale (PES), Lasater Clinical Judgment Rubric (LCJR), and the Perception to Care in Acute Situations (PCAS).

This dissertation includes two chapters based on the same study as well as a chapter of lessons learned with commentary on completing nursing education research with postpandemic nursing students. The first dataset reported are results from the SCLS and PES. These instruments are posttest only and were completed after the prebriefing and simulation experience. The second dataset reported are results from the LCJR and the PCAS. The LCJR was
used by two faculty members to rate student demonstration of clinical judgment during the simulation scenario. The PCAS was implemented as pretest/posttest; participants completed it upon arrival to their scheduled simulation then again after the simulation scenario was finished. All data were collected prior to debriefing as the groups had different debriefing experiences.

The findings of this study indicate that all participants were satisfied with the simulation and prebriefing experiences. No statistically significant differences were found between group perceptions of confidence, satisfaction, or prebriefing. There was a statistically significant increase from pretest to posttest scores on the PCAS on which participants rated themselves higher in their perceptions to care for patients. There was no interaction as there was not a statistically significant interaction between group and time. There were no statistically significant differences between groups for participant clinical judgment scores as rated by two faculty members.

Unprecedented attrition and retention were seen in the participant cohort. Though not an aim of this study, this phenomenon is attributed to the changes being seen in the postpandemic learner. More students did not return after their first year than in previous years and 49% were unsuccessful in the Fundamentals of Nursing course compared to the usual 5%.

These results show that while participants were satisfied with both interventions, and their confidence in their ability to provide care did increase after the simulation, there may not be a difference between structured and standard prebriefing. Additional studies are needed with different cohorts to determine if structured prebriefing has an effect on nursing student clinical judgment or if the unique variables caused by COVID-19 had lingering effects on these participants.


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More About This Work

Academic Units
Health and Behavior Studies
Thesis Advisors
Dickinson, Jane K.
Ed.D.C.T., Teachers College, Columbia University
Published Here
February 28, 2024