Técnica de debriefing oral orientado por instructor en la simulación clínica en enfermería: revisión integrativa

Nascimento, Juliana da Silva Garcia; Pires, Fabiana Cristina; Castro, João Pedro Resende; Nascimento, Kleiton Gonçalves do; Oliveira, Jordana Luiza Gouvêa de; Dalri, Maria Celia Barcellos

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 74 (suppl 5) • 2021 • https://doi.org/10.1590/0034-7167-2019-0750 copiar

Técnica de debriefing oral orientado por instructor en la simulación clínica en enfermería: revisión integrativa

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Analizar las evidencias científicas disponibles en la literatura sobre los elementos que hacen viable la técnica de debriefing oral orientado por instructor en la simulación clínica en enfermería.

Métodos:

Revisión integrativa de la literatura realizada en las fuentes de información: PubMed^®, Scopus, Web of Science, Literatura Latinoamericana y del Caribe en Ciencias de Salud (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL) y Educational Resources Information Centre (ERIC).

Resultados:

Se identificaron 284 estudios, y 5 compusieron la muestra. Cuatro elementos constituyen el debriefing oral: características del instructor; formato de la discusión, estructura del debriefing; y tiempo. El principal beneficio ha sido desarrollar habilidades cognitivas y psicomotrices; y el desafío, establecer entrenamiento a los instructores. Los estudios presentaron alta calidad metodológica.

Consideraciones finales:

La profundización científica cuanto a los elementos, beneficios y desafíos del debriefing oral posibilita su ejecución y confiere calidad al proceso para enfermería.

Descriptores:
Estudiantes; Simulación; Educación en Enfermería; Enfermería; Entrenamiento por Simulación

Libraries and databases	Descriptors and keywords	Search strategy
PubMed^®	MESH: "Students, Nursing"; "Simulation Training" Keywords: Debriefing; "I nstructor-led debriefing"	(("Students, Nursing" [MESH] OR "Pupil Nurses" [TIAB] OR "Student, Nursing" [TIAB] OR "Nurses, Pupil" [TIAB] OR "Nurse, Pupil" [TIAB] OR "Pupil Nurse" [TIAB] OR "Nursing Student" [TIAB] OR "Nursing Students" [TIAB] AND Debriefing AND "Instructor-led debriefing" AND "Simulation Training" [MESH] OR "Training, Simulation" [TIAB]))Search limiters: not used
Scopus	MESH: "Students, Nursing "Simulation Training" Keywords: Debriefing; "I nstructor-led debriefing"	TITLE-ABS-KEY ("Students, Nursing" OR "Pupil Nurses" OR "Student,Nursing" OR "Nurses, Pupil" OR "Nurse, Pupil" OR "PupilNurse" OR "Nursing Student" OR "Nursing Students") AND (Debriefing) AND ("Instructor-led debriefing") AND ("Simulation Training" OR "Training, Simulation" ) Search limiters: not used
CINAHL	Titles "Students, Nursing "; Simulations Keywords: Debriefing ; " Instructor-led debriefing"	(("Students, Nursing") AND (Debriefing) AND ("Instructor-leddebriefing") AND (Simulations) Search limiters: not used
LILACS	DeCs "Students, Nursing" Simulationand its Portuguese and Spanish versions Keywords: Debriefing" "Instructor-led debriefing" and its Portuguese and Spanish versions	("Students, Nursing") AND (Debriefing)AND ("Instructor-leddebriefing") AND (Simulation) ("Estudiantes de Enfermería") AND (Interrogatorio)AND ("Interrogatorio dirigido por instructor") AND (Simulación) (("Estudantes de Enfermagem") AND (Debriefing) AND ("Debriefing orientado por instrutor") AND (Simulação)) Search limiters: not used
Web of Science	"Students, Nursing"; "Simulation Training" Keywords: Debriefing; "Instructor-led debriefing"	TS=(Students, Nursing AND Debriefing AND Instructor-leddebriefing AND Simulation Training) Indexes=SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI Allotted time=Every year
ERIC	"Students, Nursing"; Simulations Keywords: Debriefing; "Instructor-led debriefing"	(("Students, Nursing") AND (Debriefing) AND ("Instructor-leddebriefing") AND (Simulations)) Search limiters: not used

Title	Year Country	Outline/number of participants	Interventions	Outcomes	Levels of Evidence
Comparison of student self-debriefing versus instructor debriefing in nursing simulation: A quasi-experimental study⁽⁷7 Kang K, Yu M. Comparison of student self-debriefing versus instructor debriefing in nursing simulation: a quasi-experimental study. Nurse Educ Today. 2018;65:67-73. https://doi.org/10.1016/j.nedt.2018.02.030 https://doi.org/10.1016/j.nedt.2018.02.0... ⁾	2018 South Korea	Quasi-experimental study/ n = 63 nursing students	Instructor-led oral debriefing (control group) versus self-debriefing (intervention group)	Instructor-led oral debriefing proved effective in solving nursing problems and satisfying participants.	3
Comparison of instructor-led versus peer-led debriefing in nursing students⁽⁹9 Roh YS, Kelly M, Ha EH. Comparison of instructor-led versus peer-led debriefing in nursing students. Nurs Health Sci. 2016;18(2);238-45. https://doi.org/10.1111/nhs.12259 https://doi.org/10.1111/nhs.12259... ⁾	2016 South Korea	Quasi-experimental study of the before and after type/ n = 65 nursing students	Oral debriefing with instructor (control group) versus peer debriefing (intervention group)	Instructor-led oral debriefing proved to be more effective compared to the peer-led debriefing. Instructor-led debriefing is an effective method for improving cardiopulmonary resuscitation skills.	3
Instructor-led vs. peer-led debriefing in preoperative care simulation using standardized patients⁽¹⁶16 Kim SK, Gagne JC. Instructor-led vs. peer-led debriefing in preoperative care simulation using standardized patients. Nurse Educ Today . 2018;71:34-9. https://doi.org/10.1016/j.nedt.2018.09.001 https://doi.org/10.1016/j.nedt.2018.09.0... ⁾	2018 South Korea	Quasi-experimental study; of the before and after type/ n = 57 nursing students	Instructor-led oral debriefing versus peer-led debriefing	The nursing skills for preoperative care (p < 0.001) and the quality of debriefing (p < 0.001) were statistically higher in the group of instructor-led oral debriefing techniques. Oral debriefing with an instructor is effective for learning in nursing.	3
Peer-Led Written Debriefing Versus Instructor-led Oral Debriefing: Using Multimode Simulation⁽¹⁷17 Ha Eun-Ho, Lim EJ. Peer-Led written debriefing versus instructor-led oral debriefing: using multimode simulation. Clin Simul Nurs . 2018;18:38-46. https://doi.org/10.1016/j.ecns.2018.02.002 https://doi.org/10.1016/j.ecns.2018.02.0... ⁾	2018 South Korea	Quasi-experimental study/ n = 122 nursing students	Instructor-led oral debriefing (control group) versus written peer-led debriefing	As for knowledge, there was no statistically significant difference between the two groups (p = 0.940), but self-confidence and satisfaction were better evaluated in the control group (p = 0.010). Instructor-led oral debriefing can be as effective as written peer debriefing	3
The Importance of Debriefing in Simulation-Based Learning: Comparison Between Debriefing and No Debriefing⁽¹⁸18 Ryoo EN, Ha EH. The importance of debriefing in simulation-based learning: comparison between debriefing and no debriefing. Comput Inform Nurs. 2015;33(12):538-45. https://doi.org/10.1097/CIN.0000000000000194 https://doi.org/10.1097/CIN.000000000000... ⁾	2015 South Korea	Quasi-experimental study/ n = 49 nursing students	Instructor-led oral debriefing (intervention group) versus no debriefing (control group)	There was a statistically significant difference for the group that used debriefing regarding clinical performance competence (p < 0.001), nursing skills (p = 0.022), task management (p <0.001), decision making (p < 0.001), teamwork (p < 0.001) and communication (p < 0.001).	3

Elements	Description
Instructor characteristics	Requires the presence of an instructor/facilitator, formally and properly trained, and the instructor who conducts the simulation must also provide debriefing⁽⁷7 Kang K, Yu M. Comparison of student self-debriefing versus instructor debriefing in nursing simulation: a quasi-experimental study. Nurse Educ Today. 2018;65:67-73. https://doi.org/10.1016/j.nedt.2018.02.030 https://doi.org/10.1016/j.nedt.2018.02.0... ^,⁹9 Roh YS, Kelly M, Ha EH. Comparison of instructor-led versus peer-led debriefing in nursing students. Nurs Health Sci. 2016;18(2);238-45. https://doi.org/10.1111/nhs.12259 https://doi.org/10.1111/nhs.12259... ^,¹⁶16 Kim SK, Gagne JC. Instructor-led vs. peer-led debriefing in preoperative care simulation using standardized patients. Nurse Educ Today . 2018;71:34-9. https://doi.org/10.1016/j.nedt.2018.09.001 https://doi.org/10.1016/j.nedt.2018.09.0... ⁾.
Discussion format	Face-to-face discussion with a relationship management model⁽⁷7 Kang K, Yu M. Comparison of student self-debriefing versus instructor debriefing in nursing simulation: a quasi-experimental study. Nurse Educ Today. 2018;65:67-73. https://doi.org/10.1016/j.nedt.2018.02.030 https://doi.org/10.1016/j.nedt.2018.02.0... ^,⁹9 Roh YS, Kelly M, Ha EH. Comparison of instructor-led versus peer-led debriefing in nursing students. Nurs Health Sci. 2016;18(2);238-45. https://doi.org/10.1111/nhs.12259 https://doi.org/10.1111/nhs.12259... ^,¹⁶16 Kim SK, Gagne JC. Instructor-led vs. peer-led debriefing in preoperative care simulation using standardized patients. Nurse Educ Today . 2018;71:34-9. https://doi.org/10.1016/j.nedt.2018.09.001 https://doi.org/10.1016/j.nedt.2018.09.0... 17 Ha Eun-Ho, Lim EJ. Peer-Led written debriefing versus instructor-led oral debriefing: using multimode simulation. Clin Simul Nurs . 2018;18:38-46. https://doi.org/10.1016/j.ecns.2018.02.002 https://doi.org/10.1016/j.ecns.2018.02.0... ^-¹⁸18 Ryoo EN, Ha EH. The importance of debriefing in simulation-based learning: comparison between debriefing and no debriefing. Comput Inform Nurs. 2015;33(12):538-45. https://doi.org/10.1097/CIN.0000000000000194 https://doi.org/10.1097/CIN.000000000000... ⁾.
Structure/procedure	Oral debriefing technique led by an instructor with a structured method in three phases: gather; analyze and summarize (G.A.S debriefing^* * G.A.S debriefing is formed of three steps: gather (G), analyze (A) and summarize (S). ⁽⁷7 Kang K, Yu M. Comparison of student self-debriefing versus instructor debriefing in nursing simulation: a quasi-experimental study. Nurse Educ Today. 2018;65:67-73. https://doi.org/10.1016/j.nedt.2018.02.030 https://doi.org/10.1016/j.nedt.2018.02.0... ^,⁹9 Roh YS, Kelly M, Ha EH. Comparison of instructor-led versus peer-led debriefing in nursing students. Nurs Health Sci. 2016;18(2);238-45. https://doi.org/10.1111/nhs.12259 https://doi.org/10.1111/nhs.12259... ^,¹⁷17 Ha Eun-Ho, Lim EJ. Peer-Led written debriefing versus instructor-led oral debriefing: using multimode simulation. Clin Simul Nurs . 2018;18:38-46. https://doi.org/10.1016/j.ecns.2018.02.002 https://doi.org/10.1016/j.ecns.2018.02.0... ⁾. G.A.S debriefing, a structured method of debriefing, has been recommended by the literature as the main procedure to enable the instructor-led oral debriefing technique, especially in nursing experiences that involve the teaching and learning process of urgency and emergency⁽⁷7 Kang K, Yu M. Comparison of student self-debriefing versus instructor debriefing in nursing simulation: a quasi-experimental study. Nurse Educ Today. 2018;65:67-73. https://doi.org/10.1016/j.nedt.2018.02.030 https://doi.org/10.1016/j.nedt.2018.02.0... ^,⁹9 Roh YS, Kelly M, Ha EH. Comparison of instructor-led versus peer-led debriefing in nursing students. Nurs Health Sci. 2016;18(2);238-45. https://doi.org/10.1111/nhs.12259 https://doi.org/10.1111/nhs.12259... ^,¹⁶16 Kim SK, Gagne JC. Instructor-led vs. peer-led debriefing in preoperative care simulation using standardized patients. Nurse Educ Today . 2018;71:34-9. https://doi.org/10.1016/j.nedt.2018.09.001 https://doi.org/10.1016/j.nedt.2018.09.0... ⁾. In this method, the instructor starts the "gather" phase, reassuring the participants and encouraging them to expose their feelings about the scene experienced in the clinical simulation. Then, it proceeds to the analysis phase, which addresses the articulation of the desired theoretical framework and the experience, consolidating the desired knowledge. Finally, the summary phase, in which some thought is given on the strengths experienced and those that need improvement, reflecting how this learning can be applied in real future situations⁽⁷7 Kang K, Yu M. Comparison of student self-debriefing versus instructor debriefing in nursing simulation: a quasi-experimental study. Nurse Educ Today. 2018;65:67-73. https://doi.org/10.1016/j.nedt.2018.02.030 https://doi.org/10.1016/j.nedt.2018.02.0... ^,⁹9 Roh YS, Kelly M, Ha EH. Comparison of instructor-led versus peer-led debriefing in nursing students. Nurs Health Sci. 2016;18(2);238-45. https://doi.org/10.1111/nhs.12259 https://doi.org/10.1111/nhs.12259... ^,¹⁶16 Kim SK, Gagne JC. Instructor-led vs. peer-led debriefing in preoperative care simulation using standardized patients. Nurse Educ Today . 2018;71:34-9. https://doi.org/10.1016/j.nedt.2018.09.001 https://doi.org/10.1016/j.nedt.2018.09.0... ⁾.
Time frame	Two to three times higher than the scenario⁽¹⁶16 Kim SK, Gagne JC. Instructor-led vs. peer-led debriefing in preoperative care simulation using standardized patients. Nurse Educ Today . 2018;71:34-9. https://doi.org/10.1016/j.nedt.2018.09.001 https://doi.org/10.1016/j.nedt.2018.09.0... ^,¹⁸18 Ryoo EN, Ha EH. The importance of debriefing in simulation-based learning: comparison between debriefing and no debriefing. Comput Inform Nurs. 2015;33(12):538-45. https://doi.org/10.1097/CIN.0000000000000194 https://doi.org/10.1097/CIN.000000000000... ⁾.

Question	Study 7	Study 9	Study 16	Study 17	Study 18
1. Is it clear in the study what is the "cause" and what is the "effect" (i.e. there is no confusion about which variable comes first)?	Yes	Yes	Yes	Yes	Yes
2. Were the participants included in any similar comparisons?	Yes	Yes	Yes	Yes	Yes
3. Were the participants included in any comparisons receiving similar treatment/care, other than the exposure or intervention of interest?	Yes	Yes	Yes	Yes	Yes
4. Was there a control group?	Yes	Yes	Yes	Yes	Yes
5. Were there multiple measurements of the outcome both pre and post the intervention/exposure?	No	No	No	No	No
6. Was follow up complete and, if not, were differences between groups in terms of their follow up adequately described and analyzed?	Yes	Yes	Yes	Yes	Yes
7. Were the outcomes of participants included in any comparisons measured in the same way?	Yes	Yes	Yes	Yes	Yes
8. Were outcomes measured in a reliable way?	Yes	Yes	Yes	Yes	Yes
9. Was appropriate statistical analysis used?	Yes	Yes	Yes	Yes	Yes

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[1] Corresponding author: Juliana da Silva Garcia Nascimento. E-mail: mestradounesp28@yahoo.com.br