Effect of Debriefing Based on the Clinical Judgment Model on Simulation Based Learning Outcomes of End-of-Life Care for Nursing Students: A Non-Randomized Controlled Trial

Kyung In Jeong; Ja Yun Choi

doi:10.4040/jkan.2017.47.6.842

Journal List > J Korean Acad Nurs > v.47(6) > 1003288

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Jeong and Choi: Effect of Debriefing Based on the Clinical Judgment Model on Simulation Based Learning Outcomes of End-of-Life Care for Nursing Students: A Non-Randomized Controlled Trial

Original Article

J Korean Acad Nurs 2017;47(6):842-853.

Published online: 15 January 2017

DOI: https://doi.org/10.4040/jkan.2017.47.6.842

Effect of Debriefing Based on the Clinical Judgment Model on Simulation Based Learning Outcomes of End-of-Life Care for Nursing Students: A Non-Randomized Controlled Trial

Kyung In Jeong¹, Ja Yun Choi^2,

¹Department of Nursing, Daedong College, Busan

²College of Nursing, Chonnam National University · Chonnam Research Institute of Nursing Science, Gwangju, Korea

Address reprint requests to : Choi, Ja Yun College of Nursing, Chonnam National University · Chonnam Research Institute of Nursing Science, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-530-4943 Fax: +82-62-220-4544 E-mail: choijy@jnu.ac.kr

Received 19 July 2017 Revised 5 December 2017 Accepted 6 December 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

This study was conducted to identify effects of debriefing based on the clinical judgment model for nursing students on their knowledge, skill performance, clinical judgment, self-confidence and learner satisfaction during simulation based end-of-life care (ELC) education.

Methods

Simulation based ELC education was developed in six steps as follows: selection of learning subjects and objects, development of learning tools, a trial run of simulation-based education, students’ skill training, and evaluators’ training. Forty-eight senior nursing students (25 in the experimental group and 23 in the control group) participated in the simulation-based ELC education using a high-fidelity simulator. Debriefing based on the clinical judgment was compared with the usual debriefing.

Results

ANCOVA showed that there were differences in knowledge (F=4.81, p=.034), skill performance (F=68.33, p<.001), clinical judgment (F=18.33, p<.001) and self-confidence (F=4.85, p=.033), but no difference in satisfaction (t=-0.38, p=.704) between the experimental and control groups.

Conclusion

This study found that debriefing based on the clinical judgement model is effective for supporting nursing students for reflecting on clinical judgment and improving their diverse competencies in complex clinical settings such as ELC.

Keywords: Simulation training, Formative feedback, Nursing students, Hospice care, Judgment

References

1. Korea National Statistical Office. Annual report on the cause of death statistics [Internet]. Daejeon: Korea National Statistical Office;c2015. [cited 2017 May 1]. Available from:. http://kostat.go.kr/portal/korea/index.action.

2. Caton AP, Klemm P. Introduction of novice oncology nurses to end-of-life care. Clinical Journal of Oncology Nursing. 2006; 10(5):604–608. https://doi.org/10.1188/06.CJON.604-608.

3. Hamilton CA. The simulation imperative of end-of-life education. Clinical Simulation in Nursing. 2010; 6(4):131–138. https://doi.org/10.1016/j.ecns.2009.08.002.

4. Sorensen R, Iedema R. Emotional labour: Clinicians’ attitudes to death and dying. Journal of Health Organization and Management. 2009; 23(1):5–22. https://doi.org/10.1108/14777260910942524.

5. Eun Y, Bang SY. Effects of the Lasater’s clinical rubric of debriefing in advanced cardiovascular life support training. Journal of the Korea Contents Association. 2016; 16(4):516–527. https://doi.org/10.5392/JKCA.2016.16.04.516.

6. Raemer D, Anderson M, Cheng A. Fanning R, Nadkarni V, Savoldelli G. Research regarding debriefing as part of the learning process. Simulation in Healthcare. 2011; 6(Suppl):S52–S57. https://doi.org/10.1097/SIH.0b013e31822724d0.

7. Kim EJ. Nursing students’clinical judgment skills in simulation: Using Tanner’s clinical judgment model. The Journal of Korean Academic Society of Nursing Education. 2014; 20(2):212–222. https://doi.org/10.5977/jkasne.2014.20.2.212.

8. Kim HJ. The effects of suction care self video-based debriefing-assisted learning in the fundamentals of nursing practice. Journal of Korean Academic Society of Home Health Care Nursing. 2015; 22(1):88–97.

9. Koh JH, Hur HK. Effects of simulation-based training for basic life support utilizing video-assisted debriefing on non-technical and technical skills of nursing students. Korean Journal of Adult Nursing. 2016; 28(2):169–179. https://doi.org/10.7475/kjan.2016.28.2.169.

10. Oh HK. Effects of debriefing applying the clinical judgment rubric on nursing students’ knowledge, skill performance and simulation effectiveness. Advanced Science and Technology Letters. 2015; 116:104–109. https://doi.org/10.14257/astl.2015.116.22.

11. Levett-Jones T, Lapkin S. A systematic review of the effectiveness of simulation debriefing in health professional education. Nurse Education Today. 2014; 34(6):e58–e63. https://doi.org/10.1016/j.nedt.2013.09.020.

12. Al Sabei SD, Lasater K. Simulation debriefing for clinical judgment development: A concept analysis. Nurse Education Today. 2016; 45:42–47. https://doi.org/10.1016/j.nedt.2016.06.008.

13. Tanner CA. Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education. 2006; 45(6):204–211.

14. Lasater K. Clinical judgment development: Using simulation to create an assessment rubric. Journal of Nursing Education. 2007; 46(11):496–503.

15. Nahm FS. Understanding effect sizes. Hanyang Medical Reviews. 2015; 35:40–43. https://doi.org/10.7599/hmr.2015.35.1.40.

16. Ministry of Health and Welfare. Introduction to hospice palliative care for palliative medical team members [Internet]. Goyang: National Cancer Center;c2012. [cited 2017 May 1]. Available from:. http://hospice.cancer.go.kr/index.do.

17. METI. Program for Nursing Curriculum Integration (PNCI) 2. Seoul: Yaksan Publishing Co.;2007. p. 1–50.

18. Shin H, Park CG, Shim K. The Korean version of the Lasater clinical judgment rubric: A validation study. Nurse Education Today. 2015; 35(1):68–72. https://doi.org/10.1016/j.nedt.2014.06.009.

19. Moreland SS, Lemieux ML, Myers A. End-of-life care and the use of simulation in a baccalaureate nursing program. International Journal of Nursing Education Scholarship. 2012; 9(1):https://doi.org/10.1515/1548-923X.2405.

20. Kim CS. Development and effect of high fidelity patient simulation education program for nursing students [dissertation]. Seoul: Catholic University of Korea;2012. p. 1–55.

21. Jeong KI. Attitudes toward death and terminal care in nursing students. Journal of the Daedong University. 2013; 20:235–249.

22. Jeffries PR. A framework for designing, implementing, and evaluating simulations used as teaching strategies in nursing. Nursing Education Perspectives. 2005; 26(2):96–103.

23. Ryoo EN, Ha EH. The importance of debriefing in simulation-based learning: Comparison between debriefing and no debriefing. Computers, Informatics, Nursing. 2015; 33(12):538–545. https://doi.org/10.1097/CIN.0000000000000194.

24. Chronister C, Brown D. Comparison of simulation debriefing methods. Clinical Simulation in Nursing. 2012; 8(7):e281–e288. https://doi.org/10.1016/j.ecns.2010.12.005.

25. Kelly MA, Hager P, Gallagher R. What matters most? Students’ rankings of simulation components that contribute to clinical judgment. Journal of Nursing Education. 2014; 53(2):97–101. https://doi.org/10.3928/01484834-20140122-08.

26. Lavoie P, Pepin J, Boyer L. Reflective debriefing to promote novice nurses’ clinical judgment after high-fidelity clinical simulation: A pilot test. Dynamics. 2013; 24(4):36–41.

27. Ha YK, Koh CK. The effects of mechanical ventilation simulation on the clinical judgment and self-confidence of nursing students. Perspectives in Nursing Science. 2012; 9(2):119–126.

28. Mariani B, Cantrell MA, Meakim C, Prieto P, Dreifuerst KT. Structured debriefing and students’ clinical judgment abilities in simulation. Clinical Simulation in Nursing. 2013; 9(5):e147–e155. https://doi.org/10.1016/j.ecns.2011.11.009.

29. Ha EH, Song HS. The effects of structured self-debriefing using on the clinical competency, self-efficacy and educational satisfaction in nursing students after simulation. The Journal of Korean Academic Society of Nursing Education. 2015; 21(4):445–454. https://doi.org/10.5977/jkasne.2015.21.4.445.

30. Ministry of Foreign Affairs. OECD 「PISA in Focus」 [Internet]. Seoul: Ministry of Foreign Affairs;c2015. [cited 2017 Sep 1]. Available from:. http://mcms.mofa.go.kr/webmodule/htsboard/template/read/hbdlegationread.jsp?typeID=15&boardid=11076&seqno=1170376&c=TITLE&t=&pagenum=1&tableName=TYPE_LEGATION&pc=&dc=&wc=&lu=&vu=&iu=&du=.

Figure 1.

Research design.

Figure 2.

Participants’ selection flow.

Table 1.

Homogeneity Test of Characteristics of Subjects (N=48)

Variables	Categories	Total	Exp. (n=25)	Cont. (n=23)	χ² or t	p
		n (%) or M±SD	n (%) or M±SD	n (%) or M±SD
Age (yr)		23.33±5.36	23.12±5.88	23.56±4.85	7.93	.720
Religion	Yes	15 (31.2%)	10 (40.0%)	5 (21.7%)	2.01	.570
	No	33 (68.8%)	15 (60.0%)	18 (78.3%)
Nursing satisfaction	Very satisfaction	5 (10.4%)	3 (12.0%)	2 (8.7%)		.487^†
	Satisfaction	32 (66.7%)	18 (72.0%)	14 (60.9%)
	Usually	11 (22.9%)	4 (16.0%)	7 (30.4%)
Previous semester grades	<3.0	4 (8.3%)	2 (8.0%)	2 (8.7%)		.625^†
	3.0~3.9	43 (89.6%)	22 (88.0%)	21 (91.3%)
	≥4.0	1 (2.1%)	1 (2.1%)	0 (0.0%)
ELC experience within 6 months	Yes	30 (62.5%)	14 (56.0%)	16 (69.6%)	−0.95	.343
	No	18 (37.5%)	11 (44.0%)	7 (30.4%)

Exp.=Experimental group; Cont.=Control group; ELC=End-of-life care education.

^†Fisher’s exact probability test.

Table 2.

Homogeneity Test of Dependent Variables (N=48)

Variables	Exp. (n=25)	Cont. (n=23)	t	p
	M±SD	M±SD
Knowledge	21.84±2.03	21.26±2.78	−0.82	.412
Clinical performance	14.48±3.79	13.21±4.53	−1.04	.300
Clinical judgment	22.94±4.42	20.22±4.17	−2.36	.022
Self-confidence	19.88±3.04	20.82±4.38	0.86	.395

Exp.=Experimental group; Cont.=Control group.

Table 3.

Comparison of Learning Outcomes between Two Groups at Posttest (N=48)

Variables	Pre-test (M±SD)		Post-test (M±SD)		F^† or t	p
	Exp. (n=25)	Cont. (n=23)	Exp. (n=25)	Cont. (n=23)
Knowledge	21.84±2.03	21.26±2.78	25.32±2.05	23.78±2.43	4.81	.034
Clinical performance	14.48±3.79	12.31±4.53	26.40±2.70	19.39±3.05	68.33	<.001
Clinical judgment	22.94±4.42	20.00±4.17	32.86±3.08	27.32±4.53	18.33	<.001
Self-confidence	19.88±3.04	20.82±4.38	26.12±2.86	24.95±2.77	4.85	.033
Learner’s satisfaction	−	−	34.48±3.30	34.13±3.00	−0.38^††	.704

Exp.=Experimental group; Cont.=Control group.

^†Result of ANCOVA controlling the values at pretest as a covariate; ^††t value.

TOOLS

Similar articles