An evaluation of simulation debriefings on student nurses' perceptions of clinical reasoning and learning transfer: A mixed methods study

To aim of this study was to explore undergraduate nursing student (n = 256) perceptions of clinical reasoning ability and learning transfer after participating in either a standard post simulation debriefing or a debriefing based on transfer of learning principles. Background: It is assumed that students will transfer what they have learned from simulation to real world practice, however, some students are unable to identify the relevance of simulated learning experiences if scenarios are dissimilar to clinical placement settings. The nature and extent what is able to be transferred from simulated to real settings is unclear, particularly in relation to complex processes such as clinical reasoning. Transfer of learning to a new situation involves deliberate cognitive effort, including reflection and mindful abstraction of central attributes of a problem. As reflection is a key element in learning transfer, the debriefing element of simulation was seen to be a platform for this study. Method: A convergent parallel mixed methods design used a pre-test, post-test survey and focus group interviews. Results: No statistically significant difference in post-test clinical reasoning scores between groups was found. There was a statistically significant improvement in 12 out of 15 criteria among the control group and in 8 of the criteria among the intervention group. Qualitative findings provided some evidence that learning had transferred to clinical settings. Evidence of “near” transfer was more evident than “far” transfer. Conclusion: Positive findings included that all students perceived they had transferred the skills of patient assessment and effective communication during episodes of patient care. The concept of a “framework” being verbalized by many of the intervention group during practice is a promising finding and may be a useful direction for further research focusing on the instructional demonstration of explicitly promoting a level of abstraction of problems and prompting participants to search for conceptual connections. This may indicate retained idea or concepts from the debriefing which may be useful in future practice