Fluctuating Cohesion: A Grounded Theory Study of Nursing Students Engaged in a Combined Debriefing Format

Simulation‐based education (SBE) encompasses three phases: prebriefing, exposure to the simulation experience and debriefing (Chamberlain, 2015). Debriefing, an essential component of SBE is defined as a structured and guided process between people, after a simulated training session (Al Sabei & Lasater, 2016). The aim of debriefing is to provide students with opportunities to reflect on individual and group performance in a psychologically safe environment where they participate and learn without fear of reprisal or embarrassment. The debriefing process may include feedback, discussion and guided reflection focused on the simulation scenario. (International Nursing Association for Clinical Simulation and Learning INACSL Standards Committee et al., 2021).

Quality standards established by the International Nursing Association for Clinical Simulation and Learning have guided U.S and international healthcare communities in the integration, implementation and advancement of simulation-based education for well over a decade (International Nursing Association for Clinical Simulation and Learning INACSL Standards Committee et al., 2021; ([INACSL]). The standards indicate effective SBE includes a debriefing process to help students comprehend learning objectives and meet desired outcomes (International Nursing Association for Clinical Simulation and Learning INACSL Standards Committee et al., 2021). Debriefing led by faculty instructors as facilitators has been a well-established practice in global SBE (Kumar & Somerville, 2024),

Despite the use of instructor-led debriefing as a common practice in SBE, recent studies indicate this format may increase students’ debriefing anxiety and pose a threat to psychological safety (Verkuyl, 2020b; Yockey & Henry, 2019), a major factor influencing learners’ capacity for reflection (Kolbe et al., 2019). Other studies yield conflicting evidence as to whether facilitator presence has a superior effect on debriefing outcomes (Christiansen et al., 2023, Kim and De Gagne, 2018, Roh et al., 2016). Considering the evidence regarding potential student anxiety associated with instructor-led debriefing and feasibility and resource allocation, the pace of investigations of alternatives to this format has accelerated.

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