Prebriefing: The Final Frontier Cathy Coram PhD RN CNE Colorado State University- Pueblo

Objectives for this Session Identify the 3 phases of a Simulation Prebriefing, Participation and Debriefing Explain the key concepts and value of prebriefing in simulation. Discuss effects of prebriefing on student anxiety/self- confidence and clinical judgment. Describe a plan and strategies to implement prebriefing into your simulation program.

Welcome! This presentation will present an overview of prebriefing in simulation. A clear definition of the process will be presented and discussed. A review of the findings from one research study utilizing prebriefing strategies will be presented. Strategies to implement prebriefing into your program of simulation will be presented.

Poll Question: How many of you currently utilize specific prebriefing strategies in your simulation program?

What is Prebriefing? Prebriefing sets the stage for simulation and assists participants in achieving scenario objectives (INASCL 2013). Standard prebriefing activities generally include orientation to the Simulation Lab, Manikins and equipment. General objectives for each scenario may be included. What types of prebriefing activities are you currently using in your simulation lab?

Prebriefing Pros and Cons Reduction in Anxiety Increased Self- Confidence Improved Performance Better time utilization Student satisfaction Requires faculty time for development Prebriefing exercises must be assessed/graded How much is enough versus too much information?

Value of Prebriefing Student satisfaction Improved preparation of students for the scenario performance Enhanced impact of debriefing as the student is more aware of expectations of the scenario Decreased faculty frustration with student preparation

Research with Prebriefing Research studying prebriefing is minimal. Strategies and methods of prebriefing vary widely. Best practices for prebriefing in simulation must be developed. This requires evidence based research to be conducted.

Concept Analysis Page-Cutrara, K. (2015, July). Prebriefing in nursing simulation: A concept analysis. Clinical Simulation in Nursing, 11(7), 335-340. http://dx.doi.org/10.1016/j.ecns.2015.05.001 Chamberlain, J. (2015, July). Prebriefing in nursing simulation: A concept analysis using Rodger’s methodology. Clinical Simulation in Nursing, 11(7), 318- 322. http://dx.doi.org/10.1016/j.ecns.2015.05.003 .

McDermott, D. S. (2016, June). The prebriefing concept: A delphi study of CHSE experts. Clinical Simulation in Nursing, 12(6), 219-227. http://dx.doi.org/10.1016/j.ecns.2016.02.001 Page-Cutrara, K. (2013). Use of prebriefing in nursing simulation: A literature review. Journal of Nursing Education, 53(3), 136-141. Rudolph, J. W., Raemer, D. B., & Simon, R. (2014). Establishing a safe container for learning in simulation. The role of the presimulation briefing. Simulation in Healthcare, 9(6), 339-349. http://dx.doi.org/10.1097/SIH.0000000000000047

Effects of Prebriefing My study of the effects of Expert Role Modeling (prebriefing strategy) on Anxiety/Self-Confidence with Clinical Decision Making Scores and Clinical Judgment Scores utilized two tools: Nursing Anxiety and Self Confidence with Clinical Decision Making Scale (NASC-CDM) for pre and post seminar measurements Lasater Clinical Judgment Rubric (LCJR) for peer, self and expert rater assessments

Anxiety/Self-Confidence The results from the NASC-CDM indicated significant changes within groups for increased self-confidence and decreased anxiety. Overall total mean change scores for both groups for self-confidence and anxiety indicated statistically significant changes. There were no significant changes between groups for increased self-confidence and decreased anxiety. Therefore, watching an expert nurse video had no impact on anxiety or self confidence levels.

Clinical Judgment Results from the LCJR indicated inflated ratings from the student self and peer analysis. There were no significant findings with this data. The expert rater data yielded support that watching an expert nurse video had a positive effect on the clinical judgment performance of the treatment group in comparison to the control group.

Limitations of the Study Prebriefing strategies not presented adequately or monitored prior to seminar Students did not prepare for the simulation seminar. This impacted the data results for the LCJR self and peer ratings. Convenience sample size was small, geographical and program type limit the generalizability of the study findings.

Conclusions from Study This study provided support that student participation in a simulation seminar can reduce anxiety and increase self-confidence in novice nursing students. Incorporating the prebriefing strategy of an expert nurse role modeling video had a positive effect on the students’ use of clinical judgment in a simulation scenario.

Application of the Findings Further refinement of prebriefing activities for simulation experiences across the curriculum Methods of ensuring that the prebriefing activities have been completed appropriately Prebriefing session held prior to each simulation day to ensure student understanding of expectations, roles and performance objectives

Evaluation of Changes Students completed the Simulation Effectiveness Tool-Modified (SET-M) for the Spring 2016 semester. Two items on the form assess student perceptions of the prebriefing phase. Results on next slide…

Creating a Destination for Documents I utilized Bb Learn to create an On Campus Clinical Course https://blackboardent.csupueblo.edu/ Separate the Courses through use of Adaptive Release Features and Link to Gradebook One General Folder for all students for orientation

Orientation Schedules and expectations for critical behaviors, safe environment for learning Numerous manikin videos available online for students to watch and familiarize themselves with the features of each manikin Confidentiality forms Online video orientation to the layout of the lab

Strategies Determine what information that you want the students to have prior to coming to the simulation lab: Scenario objectives Specific goals for the scenarios General diagnostic information for students to investigate pathophysiology for cases Pre Sim Quizzes Pre Sim Concept Mapping

Levelling Levelling of prebriefing activities is essential. There may be specific objectives, pre sim quizzes, and skills drills for a Fundamentals group. Senior students will receive less specific information regarding the scenario as they are expected to perform at a higher level.

Survey Documents and Data Collection Tools I used Google Drive and Documents to build and collect responses for all survey items. They are easy to make and embed the links to Bb and any changes made in the Cloud are automatically updated. https://mail.google.com

Questions? Please feel free to contact me with specific questions regarding prebriefing and setting up your Learning Management System course. cathy.coram@csupueblo.edu

I hope you enjoyed and learned from this presentation. Thank You! I hope you enjoyed and learned from this presentation.