Hypothesis Debriefing provides students with the opportunity to reflect on their simulation experience in relation to practice.1,2 Although instructor-led debriefing is considered the gold standard5, this needs further inquiry as results from studies are mixed and inconsistent.3,4,5 Approaches like self-debriefing and peer-debriefing or use of multimedia resources that do not require the presence of a facilitator may be a more cost-effective alternative to video-facilitated instructor debriefing6. Despite widespread support, there is little evidence to support the efficacy of the best simulation-based debriefing method. The purpose of this study was to compare the effects of peer-led (PL) debriefing compared with instructor-led (IL) debriefing among nursing students. Such research will inform and support faculty and facilitators in strategies for the promotion of learning through reflection in post-simulation debriefing. Methods This was a non-equivalent control group pretest-posttest design study. A convenience sample of 65 second-year nursing students enrolled in two-week clinical placement rotation in an intensive care unit was randomly assigned to the IL debriefing group (Group A, n = 36) or PL debriefing group (Group B, n = 29). For Group A, after completion of the pretest simulation, an experienced instructor led the debriefing session for participants to reflect on their performances. Printouts from the manikin’s SkillReporter7 and the video recording were used to reflect and analyze students’ actions. The instructor used a standardized debriefing process8 to lead the discussions about the quality of CPR skills and algorithm. Group B underwent PL debriefing, which included two participants comparing their performance with a structured adult BLS video. After the debriefing sessions, the CPR psychomotor skills of both groups were reassessed to identify any differences between the two groups. Results Descriptive statistics and t tests were calculated to summarize the quantitative data using SPSS version 21.0 program. Group differences at each testing interval were analyzed using independent samples t tests. A significance level of p=.05 was chosen. Mean difference of total penalty score in quality of cardiopulmonary resuscitation skills was significantly lower in IL debriefing group than PL group (t = 3.779, p = < .001), that means IL group performed better than PL group. The mean score of satisfaction with simulation experience in IL group was significantly higher than those of PL group (t = 2.698, p = .009). Overall, mean score of quality of debriefing was significantly higher in IL group compared to PL group (t = 4.068, p < .001). Conclusion IL debriefing is an effective method in improving skills performance, and inducing favorable satisfaction, and quality of debriefing among nursing students. This study reports students’ preference for IL debriefing in light of effectiveness, reflective practice, and feedback to participants. Although satisfaction with clinical reasoning and clinical learning was similar in both groups, the quality of subsequent CPR psychomotor skills assessed by raters and data from the simulator, and self-reported satisfaction with simulation and quality of debriefing was higher in the IL group than the PL group. As simulation grows within undergraduate nursing programs, there remains a need to establish the effects of PL debriefing as a possible alternative or addition to the curricula. The impact of the level of student experience, for example final year versus more junior students, needs to be determined if PL debriefing is to be accepted as a viable option within undergraduate nursing education.
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