Structured Debriefing for Nursing Students in Clinical Placement
By TUN Wing Yee, Elisa, RN, BN(Hons), MNurs, Medical & Surgical Ward
Debriefing is a process where nurse educators facilitate student reflections on clinical encounters. Following a clinical experience, students will be debriefed and given an opportunity to discuss on the patient care and management, thoughts and feelings during the experience, knowledge and skills for future application, professional competence, clinical reasoning, decision making, and clinical judgment skills. At Hong Kong Sanatorium & Hospital, Clinical Instructors debrief nursing students near the end of a work shift, during the students clinical placement. The session is approximately 15-20 minutes. Feedback is given and students can also raise their concerns during the clinical placement. This encourages students to translate nursing knowledge to practice.
Purpose and Problem Statement
Facilitating a debriefing session has many challenges. Firstly, clinical experiences can trigger different emotional response in students. Learning experience is obstructed as the debriefing is not focused on the patient care provided. Secondly, many Hong Kong students are not always actively engaged in discussion. Therefore, students have limited ability to express feelings and opinions. Lastly, Clinical Instructors have various debriefing methods which impacts on student learning. The purpose of this project is to determine if a structured debriefing session can improve Clinical Instructor and nursing student satisfaction on debriefing.
Pre and post-test surveys were distributed to Clinical Instructors and Nursing Students from July to August 2018 to understand their satisfaction on debriefing. A briefing session to all the Clinical Instructors on the use of “Debriefing Worksheet” was completed. A guideline was distributed to all Clinical Instructors advising them to gather nursing students to debrief after a clinical day. Students were allowed approximately 5 minutes to fill in the worksheet before the debriefing started. Students can keep the “Debriefing Worksheet” after debriefing.
Clinical Instructor debrief satisfaction was significantly improved after using the “Debriefing Worksheet”. The Clinical Instructors felt more encouragement and appreciation by the students, which allowed them to engage students more easily. Moreover, the nursing students were more motivated to attend debriefing and the sense of personal accomplishment was improved. However, no significant change was found on students confidence in sharing thoughts or expressing feelings.
Recommendations and Next Steps
In conclusion, nurse educators have to continuously debrief nursing students after a clinical day. In order to engage the students for a focused and meaningful discussion, students should be allowed at least 5 minutes to synthesize their clinical experience with the use of a “Debriefing Worksheet” before starting. It can also assist the students to reflect on their decision making and nursing actions in a structured manner. It is important for nurse educators have to identify alternatives to empower students to share their thoughts and express feelings.