Conditions for learning in simulation practice: training for team-based resuscitation in nursing education
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- PhD theses (SV-IH) 
OriginalversjonConditions for learning in simulation practice: training for team-based resuscitation in nursing education by Sissel Eikeland Husebø, Stavanger : University of Stavanger, 2012 (PhD thesis UiS, no. 173)
Background: Research demonstrates that simulation-based learning in nursing practice is a promising educational method used under appropriate conditions. Research using simulation for performing resuscitation in nursing education has been mainly concerned with the goal of justifying its use or proving that it works, while less effort has been devoted to understanding the complexity inherent in those activities. Aims: The overarching aim of the study was to develop knowledge about the critical conditions for learning team-based resuscitation in simulation-based learning environments. This aim involves an interest in how simulation can provide an arena for nursing students’ participation, how simulators can function as mediating tools for learning, and how social order is established and accounted for in simulations. Theoretical framework: Simulation practice in this thesis is studied within the socio-cultural perspective. The socio-cultural perspective views learning as taking place through participation in activities in interaction with others and artefacts. Methodology: In 2008, a total of 81 nursing students studying in their last semester of a three-year nursing education program participated in the study. The nursing students were divided into 14 groups, each of which comprised between 4-7 members. Five faculties participated as facilitators in the study. Data were generated by means of video-recordings from 14 briefings and 28 simulation scenarios and debriefings. Interaction analysis was used to analyze the briefing and simulation scenarios, whereas content analysis was used to analyze the debriefings. Several statistical procedures were applied to analyze the nursing students’ D-CPR performance in the simulation scenario. Results: In paper I the interaction analysis of the briefing revealed that four conditions are of particular importance for learning in simulation practice: a) to bridge between simulation practice and clinical practice in the briefing; b) only include skills learned in advance and in line with the specific educational level in the simulation scenario; c) provision of repetitive practice and feedback in simulated D-CPR performance, and d) secure reflection in the debriefing. In paper II the interaction analysis identified three phases of coordination in the resuscitation team: Stating unconsciousness, Preparing for resuscitation, Initiating resuscitation. The students’ coordination of joint assessments and actions in these phases involved a broad range of verbal and nonverbal communication modes that were necessary for achieving mutual understandings of how to continue to the next step in the D-CPR algorithm. In paper III, a theory-driven content analysis of the facilitators’ questions and the nursing students’ responses demonstrated that facilitators mostly asked descriptive and verifying/confirming questions, while nursing students mostly responded with descriptive replies. Nevertheless, the facilitators’ descriptive questions also elicited student responses on a more reflective level. In paper IV, the statistical analysis demonstrated that there were large variations in how accurately the nursing student teams performed the specific parts of the D-CPR algorithm. None of the nursing student teams achieved top scores on the D-CPR-checklist. Further, the findings revealed that observing one simulation scenario and participating in the following debriefing did not improve the students’ performance of D-CPR in a subsequent scenario. Conclusion: This thesis has contributed to the understanding of what goes on in the ‘black box’ of simulation practice in nursing education. The study demonstrates that the simulation-based environment is a very complex one for the nursing students to master as they must deal with both the specific conditions in this simulation-based learning environment and the tasks to be managed in resuscitation. The results of the study point to several critical conditions that are important if the learning objectives in the simulation are to be achieved. Firstly, it is of vital importance that the facilitator’s instruction does not lead to confusion regarding what the simulation is simulating. Secondly, it is important that guidance and correction of tasks is provided by the facilitator. Thirdly, to achieve coordination of resuscitation teamwork, the interplay between non-verbal and verbal communication modes must be trained and emphasized in the simulation. Fourthly, optimizing nursing students’ reflection in the debriefing requires questions on a reflective level, and fifthly, accurately team-based D-CPR performance in nursing education requires repetitive practice and feedback.
PhD thesis in Health, medicine and welfare
Består avHusebø, S.E., Friberg, F., Søreide, E. & Rystedt, H. (2011). Instructional problems in briefings: How to prepare nursing students for simulation-based cardiopulmonary resuscitation training. Clinical Simulation in Nursing doi:101016/jecns201012002 2011(0).
Husebø, S.E., Rystedt, H. & Friberg, F. (2011). Educating for teamwork - nursing students’ coordination in simulated cardiac arrest situations. Journal of Advanced Nursing, 67(10), 2239–2255.
Husebø, S.E., Dieckmann, P., Rystedt, H., Søreide, E. & Friberg, F. (2010). Reflection on leadership in resuscitation teamwork in post-simulation debriefing in nursing education.
Husebø, S.E., Bjørshol, C.A., Rystedt, H., Friberg, F. & Søreide, E. (2012). A comparative study of defibrillation and cardiopulmonary resuscitation performance during simulated cardiac arrest in nursing student teams. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 20:23, doi:10.1186/1757-7241-20-23.