Scientific method, nursing process, and experiential learning models all include phases for planning, action, and evaluation. In nursing process, we collect information, create a plan of care, implement the plan, and then evaluate it. To be consistent with nursing process, nurses should include planning in all nursing activities, and simulation-based learning experiences should be no exclusion.
In simulation-based learning experiences, we refer to this planning as prebriefing. There is a gap in the literature, however, as to what exactly should be included in prebriefing.1 Most educators agree prebriefing should include an orientation to both the simulation environment and manikins used in enacting the case scenario. Most also agree that prebriefing should include a discussion of academic integrity and review of the fiction contract.2 Some believe prebriefing can be used to identify the roles of team members and provide an introduction to the case, which will be enacted during the simulated scenario.3 In nursing process, however, planning includes the use of a nursing care plan or concept map. This critical step in nursing process is typically not included in the prebriefing stage of simulation, making simulation-based learning experiences inconsistent with nursing process, scientific method, and experiential learning principles.
Currently, debriefing has been well covered in the simulation literature. There are specific debriefing methods such as Harvard's Debriefing Assessment for Simulation in Healthcare4 and Dreifuerst's Debriefing for Meaningful Learning.5 Debriefing activities are theory based and provide both educators and learners with a structured process for evaluating performance, encouraging self-evaluation, and building knowledge. This structured process of debriefing provides a formalized method for assessing outcomes. One of the common activities in debriefing is allowing the learner to link actual with expected outcomes. But when are these expected outcomes formalized by the learner?
The need to provide an opportunity for learners to identify their expected outcomes can be addressed through structured prebriefing. Like debriefing, for prebriefing to most effective, nurse educators must reach a consensus on the fundamental components of prebriefing. Currently, Delphi studies are being conducted to identify the key concepts and components of prebriefing. Once these essential concepts and components are identified, they will play a key role in the development of structured and more formalized methods of prebriefing.
As educators work to design structured methods of prebriefing, it is essential that they keep in mind 3 important factors: theory, nursing process, and outcomes. Prebriefing design should be rooted in experiential learning theory. Simulation is an experiential learning process, and as such, experiential learning theory should be engrained in all components of simulation-based learning experiences including prebriefing. In accordance with experiential learning theory, learning is most effective when the learner is engaged in structured activities that include abstract conceptualization, active experimentation, concrete experience, and reflective observation. In active experimentation, the learner applies knowledge to a situation to identify expectations and make a plan for action.6 To be consistent with experiential learning theory, prebriefing should allow the learner time to formally identify expected outcomes and devise a plan of action.
Simulation is the replication of reality. In nursing education, simulation-based learning experiences are used to immerse learners in a realistic yet safe setting in which they can gain clinical experience. To be consistent with reality, simulation-based learning experiences should replicate what is expected of the learner in the actual clinical setting and be modeled on nursing process. In prelicensure nursing education, learners are expected to review the patient case and make a plan prior to the provision of care. This plan is shared with clinical instructors in a preconference. In simulation-based learning experiences, the replication of this preconference should be included in prebriefing. This planning component of prebriefing gives the learner an opportunity to identify expected outcomes.
The evaluation of learning is outcome based. Outcomes are directly linked to objectives. Simulation-based learning experiences have formal learning outcomes for evaluation of overall performance and skills such as communication, clinical judgment, and technical abilities. But simulation-based learning also provides an opportunity for the learner to self-evaluate. For learners to evaluate their own performance, they need to identify their expected outcomes.7 Current practices in simulation-based learning rarely provide learners a formal activity for identifying expectations. A formal prebriefing that allows for structured planning provides the learner with this opportunity and facilitates the self-evaluation that is crucial in debriefing.
Like debriefing, prebriefing is an integral component of simulation-based learning experiences. The design of prebriefing should be rooted in experiential learning theory and consistent with nursing process. Prebriefing should include an orientation to the simulation environment, discussion of academic integrity, and the fiction contract. Prebriefing should include identification of roles and introduction to the case scenario. Most importantly, prebriefing should provide the learner with an opportunity to identify expected outcomes that will be used to facilitate self-evaluation in debriefing.
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