模拟教学中护理教师实施引导性反馈的现况调查

doi:10.3761/j.issn.1672-9234.2021.11.001

摘要/Abstract

摘要：

目的了解护理院校及临床医院护理教师实施引导性反馈的现况,并分析其影响因素。方法基于国际护理临床模拟教学协会的模拟最佳实践标准及医疗模拟引导性反馈评估量表等引导性反馈评估工具编制问卷。采用方便抽样,对护理院校及临床医院的133名参与过护理模拟教学中引导性反馈实践的教师进行调查。结果 34名（25.6%）的教师认为自己胜任引导性反馈。教师实施引导性反馈遇到困难较多的有“有的学员说得太少,沉默不言”（72.9%）、“让学员积极参与到引导性反馈中”（67.7%）、“学员没有提前准备好（材料、作业任务、技能练习等）”（63.9%）。引导性反馈实施质量问卷得分为1~22（14.32±4.45）分,其中条目“在模拟案例运行时记录学员个人或团队的表现”正确率最高,为96.2%;条目“在模拟案例运行前向学员介绍引导性反馈的安排及目标”正确率最低,为38.3%。多元线性回归分析显示,年龄（β=-0.293）、开展引导性反馈的年限（β=0.177）、对INACSL模拟最佳实践标准的熟悉程度（β=0.341）、参与护理教学时间（β=0.197）和参加过相关培训（β=0.254）是引导性反馈实施质量的影响因素（调整R²=0.388,F=14.933,P<0.001）。结论护理教师引导性反馈实施质量有待提升,引导性反馈培训不足,面临学员参与度不足的挑战。应依据模拟最佳实践标准加强教师培训,以提升引导性反馈实施质量。

关键词: 教育,护理, 问卷调查, 模拟教学, 引导性反馈

Abstract:

Objective To investigate the current status of debriefing used in simulation teaching by nursing colleges and clinical teachers in China,and to analyze the influencing factors. Methods Questionnaires were developed based on INACSL simulation best practice standards and Debriefing Assessment for Simulation in Healthcare,etc. By convenience sampling,133 nursing teachers from nursing schools and clinical hospitals who had experience of debriefing in nursing simulation teaching were investigated. Results Thirty-four nursing teachers（25.6%）thought they were competent in debriefing. Nursing teachers encountered more difficulties in implementing debriefing and these difficulties included “some students talked too little or kept silent”（72.9%）,“making students actively participate in debriefing”（67.7%）,and “students did not prepare for the class in advance（materials,assignments,skill exercises,etc.）”（63.9%）. The score of the questionnaire on implementation quality of debriefing ranged from 1 to 22（14.32±4.45）. The item “recording the performance of student or team during the scenario” had the highest accuracy rate（96.2%）.The item “introducing the arrangement and objectives of debriefing to students before running the scenario” had the lowest accuracy rate of 38.3%. Multiple linear regression analysis showed that age（β=-0.293）,time to conduct debriefing（β=0.177）,familiarity with INACSL simulation best practice standards（β=0.341）,time of participating in nursing teaching（β=0.197）and participation in training（β=0.254）were the influencing factors of the quality of debriefing implementation（Adjusted R²=0.388,F=14.933,P<0.001）. Conclusion The quality of debriefing practices needs to be improved. Nursing teachers have insufficient debriefing training and face the challenges of insufficient participation of students. Specific training should be strengthened based on simulation best practice standards to improve the quality of debriefing practices.

Key words: Education,Nursing, Questionnaires, Simulation teaching, Debriefing

管静,金晓燕,董旭,杨聪颖,王志稳. 模拟教学中护理教师实施引导性反馈的现况调查[J]. 中华护理教育, 2021, 18(11): 965-971.

GUAN Jing,JIN Xiao-yan,DONG Xu,YANG Cong-ying,WANG Zhi-wen. A survey of debriefing used in simulation teaching by nursing teachers[J]. Chinese Journal of Nursing Education, 2021, 18(11): 965-971.

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参考文献 30

[1]	Hayden JK, Smiley RA, Alexander M, et al. The NCSBN national simulation study:a longitudinal,randomized,controlled study replacing clinical hours with simulation in prelicensure nursing education[J]. J Nurs Regul, 2014, 5(2):S3-S40.
[2]	王艳玲, 孙柳, 吴瑛. 情景教学在我国护理教育中的应用现状与思考[J]. 中国护理管理, 2014, 14(4):354-357.
	Wang YL, Sun L, Wu Y. Current situation and reflection of simulation teaching in nursing education in China[J]. Chin Nurs Manag, 2014, 14(4):354-357.
[3]	Jeffries PR. The NLN Jeffries simulation theory[M]. New York:National League for Nursing, 2015, 40.
[4]	INACSL Standards Committee. INACSL standards of best practice:simulation^SM debriefing[J]. Clin Simul Nurs, 2016, 12(S):S21-S25. doi: 10.1016/j.ecns.2016.09.008
[5]	Waznonis AR. Simulation debriefing practices in traditional baccalaureate nursing programs:national survey results[J]. Clin Simul Nurs, 2015, 11(2):110-119. doi: 10.1016/j.ecns.2014.10.002
[6]	Fey MK, Jenkins LS. Debriefing practices in nursing education programs:results from a national study[J]. Nurs Educ Perspect, 2015, 36(6):361-366. doi: 10.5480/14-1520
[7]	Krogh K, Bearman M, Nestel D. “Thinking on your feet”-a qualitative study of debriefing practice[J]. Adv Simul(Lond), 2016
	1:12.
[8]	Kim M, Kim S. Debriefing practices in simulation-based nursing education in South Korea[J]. Clin Simul Nurs, 2017, 13(5):201-209. doi: 10.1016/j.ecns.2017.01.008
[9]	徐丽华, 金瑞华, 王金玄, 等. 护理模拟引导者资格认证研究进展[J]. 护理研究, 2020, 34(20):3656-3660.
	Xu LH, Jin RH, Wang JX, et al. Research progress on nursing simulation facilitator certification[J]. Chin Nurs Res, 2020, 34(20):3656-3660.
[10]	罗先武, 商丽, 喻惠丹. 标准化引导性反馈在高仿真模拟教学中的应用[J]. 中华护理教育, 2020, 17(2):113-116.
	Luo XW, Shang L, Yu HD. The application of a standardized debriefing in high fidelity simulation teaching[J]. Chin J Nurs Educ, 2020, 17(2):113-116.
[11]	陆敏敏, 王君俏, 陈利群, 等. 反思模式在高仿真模拟教学引导性反馈中的应用效果[J]. 护理研究, 2017, 31(3):351-353.
	Lu MM, Wang JQ, Chen LQ, et al. Application effect of reflective model in guided feedback of high simulation teaching[J]. Chin Nurs Res, 2017, 31(3):351-353.
[12]	王璟, 王自盼, 岳树锦, 等. 我国高仿真情景模拟护理课程教学设计存在的问题及对策[J]. 护理学报, 2018, 25(22):11-15.
	Wang J, Wang ZP, Yue SJ, et al. Problems in teaching design of nursing courses with high-fidelity simulation scenario and its countermeasures[J]. J Nurs(China), 2018, 25(22):11-15.
[13]	Brett-Fleegler M, Rudolph J, Eppich W, et al. Debriefing assessment for simulation in healthcare:development and psychometric properties[J]. Simul Healthc, 2012, 7(5):288-294. doi: 10.1097/SIH.0b013e3182620228 pmid: 22902606
[14]	Gross Forneris S, Fey MK. Critical conversations:the NLN guide for teaching thinking[J]. Nurs Educ Perspect, 2016, 37(5):248-249. pmid: 27740554
[15]	李依霖, 康晓凤, 陈京立. 情景模拟教学的最佳实践标准[J]. 中国高等医学教育, 2017(12):28-29.
	Li YL, Kang XF, Chen JL. Best practice standards for scenario simulation[J]. China High Med Educ, 2017(12):28-29.
[16]	刘敦, 姜小鹰, 宋继红. 情境模拟教学在普外科护理综合实验中的应用与效果评价[J]. 中华护理教育, 2015, 12(1):34-37.
	Liu D, Jiang XY, Song JH. Effects of scenario-based simulation in the comprehensive experiment teaching of general surgical nursing[J]. Chin J Nurs Educ, 2015, 12(1):34-37.
[17]	Roh YS, Jang KI. Survey of factors influencing learner engagement with simulation debriefing among nursing students[J]. Nurs Health Sci, 2017, 19(4):485-491. doi: 10.1111/nhs.2017.19.issue-4
[18]	Zigmont JJ, Kappus LJ, Sudikoff SN. The 3D model of debriefing:defusing,discovering,and deepening[J]. Semin Perinatol, 2011, 35(2):52-58. doi: 10.1053/j.semperi.2011.01.003 pmid: 21440811
[19]	Decker S, Fey M, Sideras S, et al. Standards of best practice:simulation standard VI:the debriefing process[J]. Clin Simul Nurs, 2013, 9(6):S26-S29. doi: 10.1016/j.ecns.2013.04.008
[20]	Rudolph JW, Raemer DB, Simon R. Establishing a safe container for learning in simulation:the role of the presimulation briefing[J]. Simul Healthc, 2014, 9(6):339-349. doi: 10.1097/SIH.0000000000000047 pmid: 25188485
[21]	Page-Cutrara K. Use of prebriefing in nursing simulation:a literature review[J]. J Nurs Educ, 2014, 53(3):136-141. doi: 10.3928/01484834-20140211-07 pmid: 24512336
[22]	Sawyer T, Eppich W, Brett-Fleegler M, et al. More than one way to debrief:a critical review of healthcare simulation debriefing methods[J]. Simul Healthc, 2016, 11(3):209-217. doi: 10.1097/SIH.0000000000000148
[23]	Dreifuerst KT. Getting started with debriefing for meaningful learning[J]. Clin Simul Nurs, 2015, 11(5):268-275. doi: 10.1016/j.ecns.2015.01.005
[24]	Cheng A Rodgers DL van der Jagt É, et al. Evolution of the Pediatric Advanced Life Support course:enhanced learning with a new debriefing tool and web-based module for pediatric advanced life support instructors[J]. Pediatr Crit Care Med, 2012, 13(5):589-595. doi: 10.1097/PCC.0b013e3182417709
[25]	杨冰香, 黄润, 徐爱京, 等. 模拟教学引导性反馈的标准和策略[J]. 中华护理教育, 2020, 17(1):18-23.
	Yang BX, Huang R, Xu AJ, et al. Standards and strategies of debriefing in simulation[J]. Chin J Nurs Educ, 2020, 17(1):18-23.
[26]	刘茜. 护理模拟教学中应用引导性反馈的研究进展[J]. 护理学杂志, 2015, 30(1):96-98.
	Liu Q. Research advances of directed debriefing in simulation-based nursing teaching[J]. J Nurs Sci, 2015, 30(1):96-98.
[27]	Arafeh JM, Hansen SS, Nichols A. Debriefing in simulated-based learning:facilitating a reflective discussion[J]. J Perinat Neonatal Nurs, 2010, 24(4):302-309. doi: 10.1097/JPN.0b013e3181f6b5ec pmid: 21045608
[28]	Dreifuerst KT. The essentials of debriefing in simulation learning:a concept analysis[J]. Nurs Educ Perspect, 2009, 30(2):109-114. pmid: 19476076
[29]	Oriot D, Alinier G. Pocket book for simulation debriefing in healthcare[M]. Cham: Springer International Publishing, 2018.
[30]	Arora S, Ahmed M, Paige J, et al. Objective structured assessment of debriefing:bringing science to the art of debriefing in surgery[J]. Ann Surg, 2012, 256(6):982-988. doi: 10.1097/SLA.0b013e3182610c91