Video-assisted debriefing technique for nursing simulation: how to proceed?

To identify elements in scientific literature that make the video-assisted debriefing technique feasible in the teaching and learning process, in nursing simulation.

Method:

Integrative literature review, conducted from May to July of 2019. Primary studies, with no time frame, were selected in Portuguese, English or Spanish, in the PubMed®, Scopus®, CINAHL and LILACS databases, using the Rayyan application. Qualitative analysis was adopted.

Results:

205 studies were initially identified, six of which were selected and categorized into: “Elements that make up the video-assisted debriefing technique”; "Benefits of using the video-assisted debriefing technique" and "Challenges of using the video-assisted debriefing technique".

Conclusions:

The elements that made the video-assisted debriefing technique feasible in the teaching and learning process in nursing were concept, objectives, material resources and procedure. The main benefit was the immediate recognition of behaviors, and the challenge was the risk that the video would make debriefing tiring and humiliating.

Keywords
Students, nursing; Video recording; Simulation technique; Learning

Author and year	Origin Language	Objectives	Methodological outlining	Results	Evidence
Krogh et al, 2015 ⁽66. Krogh K, Bearman M, Nestel D. Expert practice of video-assisted debriefing: an Australian qualitative study. Clin Simul Nurs. 2015;11(3):180-7. doi: https://doi.org/10.1016/j.ecns.2015.01.003 https://doi.org/10.1016/j.ecns.2015.01.0... ⁾	Australia/English	To examine the perception of health professionals regarding the video-assisted debriefing technique.	Descriptive study with a qualitative approach, analyzed through Thematic Analysis. It approached 24 professionals from the Australian health team, about the video assisted debriefing technique in the simulation.	Four categories were identified: (1) how and when the simulation instructors use the video for debriefing - using it in clippings, exposed before the discussion; (2) impact of the video-assisted debriefing technique on learning - considered positive (3) educational approaches to the video debriefing technique - performed using pre-established scripts and protocols; (4) benefits- the main one being the visualization of behavior and challenges- the exposure of the participants.	6
Ha et al, 2014 ⁽77. Há E. Attitudes toward video-assisted debriefing after simulation in undergraduate nursing students: an application of Q methodology. Nurse Educ Today. 2014;34(6):978-84. doi: https://doi.org/10.1016/j.nedt.2014.01.003 https://doi.org/10.1016/j.nedt.2014.01.0... ⁾	South Korea/English	To identify attitudes towards the video-assisted debriefing technique in a nursing simulation.	A descriptive, quantitative and qualitative study that used the “Q methodology” to analyze the characteristics and perceptions of 44 nursing students from a university in South Korea about the video-assisted debriefing technique.	The results were placed under three categories; (1) the video-assisted debriefing technique assists in self-reflection; (2) the video-assisted debriefing technique can cause exposure and humiliation for the participants; (3) the video-assisted debriefing technique increases self-confidence. It was noted that, in general, the video-assisted debriefing technique improves both the technique and attitude of the nursing student.	6
Gamboa et al, 2018 ⁽2020. Gamboa OA, Agudelo SI, Maldonado MJ, Leguizamón DC, Sandra MC. Evaluation of two strategies for debriefing simulation in the development of skills for neonatal resuscitation: a randomized clinical trial. BMC Res Notes. 2018; 11:739. doi: https://doi.org/10.1186/s13104-018-3831-6 https://doi.org/10.1186/s13104-018-3831-... ⁾	Colombia/English	To compare the effectiveness of oral debriefing and the video-assisted debriefing technique for the development of neonatal resuscitation skills in nursing.	Experimental, randomized study carried out with 24 professionals from the health team in a university hospital in Colombia. One group received oral debriefing (control) and the other the video-assisted debriefing technique (intervention).	Both strategies improve resuscitation skills, reaching 100% compliance in the third scenario assessed. No significant differences were found between the two discussion strategies. The coefficient of difference in skills improvement percentage between the two types of debriefing was -3.6% (95% confidence interval). Presenting 6,34% for oral debriefing and -0.19% for the video-assisted technique.	2
Jacobs, 2017 ⁽2121. Jacobs PJ. Using high-fidelity simulation and video-assisted debriefing to enhance obstetrical hemorrhage mock code training. J Nurses Prof Dev. 2017;33(5):234-9. doi: https://doi.org/10.1097/NND.0000000000000387 https://doi.org/10.1097/NND.000000000000... ⁾	United States/English	To explore the performance of the nursing team using the video-assisted debriefing technique.	A quasi-experimental, before and after type study, that evaluated the knowledge of 84 nurses during a simulation on obstetric hemorrhage using the video-assisted debriefing technique.	16 debriefing sessions were carried out, with a descriptive record of the participants' responses, indicating generalized unease during the visualization of the scenario through the video-assisted debriefing technique, but appreciation for observing their own performance and reflecting on their actions. It was pointed out that good debriefing is by “thinking out loud”, being respectful, repeating and clarifying information and being able to ask questions. In post-simulation research, the majority of participants indicated a rating of 5 = totally agree or 4 = agree, in the four questions asked about debriefing, which were worth 5 points each. The averages ranged from 4.3 to 4.5 correct answers.	3
Megel et al, 2013 ⁽2222. Megel ME, Bailey C, Schnell A, Whiteaker D, Vogel A. High-fidelity simulation: how are we using the videos? Clin Simul Nurs. 2013;9: e305-e310. doi: https://doi.org/10.1016/j.ecns.2012.04.003 https://doi.org/10.1016/j.ecns.2012.04.0... ⁾	United States/English	To identify the behavior of nursing students using the video-assisted debriefing technique.	A quasi-experimental study carried out with nursing students at an American university, using the video-assisted debriefing technique to identify patient safety behavior.	After performing the video-assisted debriefing technique with 52 students (100%), 84.6% of them correctly mentioned the need to wash their hands before providing care. Only 46% considered raising the head of the patient's bed and identified errors in the intravenous infusion. 34.6% of students did not wear gloves to provide direct assistance, and 34.6% did not assess the characteristics of the wounds. The video recordings highlighted behaviors that need more teaching and reinforcement for best pediatric practices.	3
MacLean et al, 2019 ⁽2323. MacLean S, Geddes F, Kelly M, Della P. Video reflection in discharge communication skills training with simulated patients: a qualitative study of nursing students’ perceptions. Clin Simul Nurs. 2019; 28:15-24. doi: https://doi.org/10.1016/j.ecns.2018.12.006 https://doi.org/10.1016/j.ecns.2018.12.0... ⁾	Australia/English	To explore the perceptions of nursing students about their experience after using the video-assisted debriefing technique.	A qualitative study that analyzed the perception of 141 students from a nursing course at an Australian university, divided into 3 groups for debriefing.	Six themes were identified, namely: (1) realism, (2) non-verbal communication, (3) verbal communication skills, (4) reflective learning, (5) becoming a nurse and (6) the patient's needs. Through the analysis of these categories, it was possible to report that video-assisted reflection results in a high level of self-awareness, confidence and a sense of achievement.	6

Elements	Description
Definition	Use of audiovisual capture from simulation for debriefing, to support learning, allow students to see and hear their own performance, and identify needs for improvement ⁽66. Krogh K, Bearman M, Nestel D. Expert practice of video-assisted debriefing: an Australian qualitative study. Clin Simul Nurs. 2015;11(3):180-7. doi: https://doi.org/10.1016/j.ecns.2015.01.003 https://doi.org/10.1016/j.ecns.2015.01.0... ^,2222. Megel ME, Bailey C, Schnell A, Whiteaker D, Vogel A. High-fidelity simulation: how are we using the videos? Clin Simul Nurs. 2013;9: e305-e310. doi: https://doi.org/10.1016/j.ecns.2012.04.003 https://doi.org/10.1016/j.ecns.2012.04.0... ^-2323. MacLean S, Geddes F, Kelly M, Della P. Video reflection in discharge communication skills training with simulated patients: a qualitative study of nursing students’ perceptions. Clin Simul Nurs. 2019; 28:15-24. doi: https://doi.org/10.1016/j.ecns.2018.12.006 https://doi.org/10.1016/j.ecns.2018.12.0... ⁾
Objectives	To visualize student performance, looking for specific behaviors, reflect and develop competence ⁽66. Krogh K, Bearman M, Nestel D. Expert practice of video-assisted debriefing: an Australian qualitative study. Clin Simul Nurs. 2015;11(3):180-7. doi: https://doi.org/10.1016/j.ecns.2015.01.003 https://doi.org/10.1016/j.ecns.2015.01.0... ^,2020. Gamboa OA, Agudelo SI, Maldonado MJ, Leguizamón DC, Sandra MC. Evaluation of two strategies for debriefing simulation in the development of skills for neonatal resuscitation: a randomized clinical trial. BMC Res Notes. 2018; 11:739. doi: https://doi.org/10.1186/s13104-018-3831-6 https://doi.org/10.1186/s13104-018-3831-... ⁾.
Material resources	Basic audiovisual capture (smartphone, or camcorder, or complex audiovisual capture): centers with complex mannequins, associated with digital outputs, multiple cameras and microphones for recording audio and photos stored on a hard disk using a converter, which mixes the mannequin and information with synchronized images and audio ⁽66. Krogh K, Bearman M, Nestel D. Expert practice of video-assisted debriefing: an Australian qualitative study. Clin Simul Nurs. 2015;11(3):180-7. doi: https://doi.org/10.1016/j.ecns.2015.01.003 https://doi.org/10.1016/j.ecns.2015.01.0... ⁾.
Procedure	Considerations for performing the assisted video debriefing technique: (1) The video recording equipment must be set before each simulation, to guarantee the quality. (2) Students need to be informed during the briefing/pre-briefing of the intended capture, how it will be used and consent to this. (3) The technique must be performed by a specialized technician. (4) Participants must be taken to the debriefing room, arranged in chairs in a semicircle. (5) The recording device must be connected to the laptop and projected on a screen. (6) Debriefing must be double or triple the scene, in relation to time. The debriefing usually lasts 20 to 50 minutes when using video (7) Viewing the entire video is less common. If this occurs, the facilitator must stop the video to allow discussion of relevant points. It is recommended to expose segments or clippings of the video and highlight the learning objectives. Use short and limited clips (one to three). (8) The video can be exposed after the debriefing reaction phase, or before the start of the debriefing. It is recommended the video be exposed after the reaction phase. Highlight to the video debriefing period. The choice to use the entire video or clippings and the debriefing period in which the video will be spent ⁽66. Krogh K, Bearman M, Nestel D. Expert practice of video-assisted debriefing: an Australian qualitative study. Clin Simul Nurs. 2015;11(3):180-7. doi: https://doi.org/10.1016/j.ecns.2015.01.003 https://doi.org/10.1016/j.ecns.2015.01.0... ^.2121. Jacobs PJ. Using high-fidelity simulation and video-assisted debriefing to enhance obstetrical hemorrhage mock code training. J Nurses Prof Dev. 2017;33(5):234-9. doi: https://doi.org/10.1097/NND.0000000000000387 https://doi.org/10.1097/NND.000000000000... ⁾.
Benefits	The main benefit is immediate recognition of behaviors that require changes after viewing the video about yourself or your peers. Other benefits: improved debriefing by viewing the video, evaluation of actions and improvement in clinical thinking processes, identification of critical interventions and nursing skills through self-reflection and the development of clinical judgment, event recall to improve the learning process and allow the creation of an intervention record, analysis of the video by the facilitators to assess whether all students participated, increased students' self-confidence and self-reflection; reducing memory bias and providing evidence of actions during the simulated scenario; improvement of teamwork and communication between the interdisciplinary team; improvement of results for patients ⁽77. Há E. Attitudes toward video-assisted debriefing after simulation in undergraduate nursing students: an application of Q methodology. Nurse Educ Today. 2014;34(6):978-84. doi: https://doi.org/10.1016/j.nedt.2014.01.003 https://doi.org/10.1016/j.nedt.2014.01.0... ^,2121. Jacobs PJ. Using high-fidelity simulation and video-assisted debriefing to enhance obstetrical hemorrhage mock code training. J Nurses Prof Dev. 2017;33(5):234-9. doi: https://doi.org/10.1097/NND.0000000000000387 https://doi.org/10.1097/NND.000000000000... ^,2323. MacLean S, Geddes F, Kelly M, Della P. Video reflection in discharge communication skills training with simulated patients: a qualitative study of nursing students’ perceptions. Clin Simul Nurs. 2019; 28:15-24. doi: https://doi.org/10.1016/j.ecns.2018.12.006 https://doi.org/10.1016/j.ecns.2018.12.0... ⁾.
Challenges	Main challenge: the video can make debriefing tiring and humiliating. Other challenges: distractions during the debriefing process, dependence on an audiovisual mediator, the risk of being punitive and harming students; the decision to only show clippings of the video can generate a bias regarding the instructor's perspective during debriefing ⁽66. Krogh K, Bearman M, Nestel D. Expert practice of video-assisted debriefing: an Australian qualitative study. Clin Simul Nurs. 2015;11(3):180-7. doi: https://doi.org/10.1016/j.ecns.2015.01.003 https://doi.org/10.1016/j.ecns.2015.01.0... ^,77. Há E. Attitudes toward video-assisted debriefing after simulation in undergraduate nursing students: an application of Q methodology. Nurse Educ Today. 2014;34(6):978-84. doi: https://doi.org/10.1016/j.nedt.2014.01.003 https://doi.org/10.1016/j.nedt.2014.01.0... ^,2323. MacLean S, Geddes F, Kelly M, Della P. Video reflection in discharge communication skills training with simulated patients: a qualitative study of nursing students’ perceptions. Clin Simul Nurs. 2019; 28:15-24. doi: https://doi.org/10.1016/j.ecns.2018.12.006 https://doi.org/10.1016/j.ecns.2018.12.0... ⁾.

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