title: Nursing students' perceptions of learning after high fidelity simulation: Effects of a Three-step Post-simulation Reflection Model.
abstract: BACKGROUND
  High-fidelity simulation (HFS) has become a bridge between theoretical knowledge and practical skills. A safe and realistic environment is commonly used in nursing education to improve cognitive, affective and psychomotor abilities. Debriefing following a simulation experience provides opportunities for students to analyze and begin to reflect upon their decisions, actions and results. The nursing literature highlights the need to promote the concept of reflective practice and to assist students in reflection, and research indicates the need to refine and develop debriefing strategies, which is the focus of the current paper.
  
  
  OBJECTIVE
  To explore the value of reflections after HFS by investigating nursing students' perceptions of their learning when a Three-step Post-simulation Reflection Model is used.
  
  
  METHODS
  A qualitative descriptive research approach was applied.
  
  
  METHODS
  A Three-step Post-simulation Reflection Model that combined written and verbal reflections was used after an HFS experience in a second-year course in the Bachelor Program in Nursing at Luleå University of Technology, Sweden. Reflective texts written before and after a verbal group reflection were subjected to qualitative content analysis.
  
  
  RESULTS
  The main theme in the first written reflections was identified as "Starting to act as a nurse", with the following categories: feeling stressed, inadequate and inexperienced; developing an awareness of the importance of never compromising patient safety; planning the work and prioritizing; and beginning to understand and implement nursing knowledge. The main theme in the second written reflections was identified to be "Maturing in the profession", with the following categories: appreciating colleagues, good communication and thoughtfulness; gaining increased self-awareness and confidence; and beginning to understand the profession.
  
  
  CONCLUSIONS
  The Three-step Post-simulation Reflection Model fostered an appreciation of clear and effective communication. Having time for thoughtfulness and reflection promotes self-awareness and a better understanding of both the nursing profession and patient safety. The progress demonstrated in the depth of the themes in the written reflections indicates that repeated reflections stimulate and enhance student learning. The findings point towards the potential effectiveness of alternate methods of reflections.
authors.affiliation: Department of Health Science, Luleå University of Technology, Luleå, Sweden. Electronic address: orjan.lestander@ltu.se.
authors.forename: Örjan
authors.initials: Ö
authors.lastname: Lestander
authors.affiliation: Department of Health Science, Luleå University of Technology, Luleå, Sweden.
authors.forename: Niklas
authors.initials: N
authors.lastname: Lehto
authors.affiliation: Department of Health Science, Luleå University of Technology, Luleå, Sweden. Electronic address: asa.engstrom@ltu.se.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Engström
mesh_terms: D001364:Awareness; D003142:Communication; D004508:Education, Nursing, Baccalaureate; D000070856:High Fidelity Simulation Training / Q000379:methods*; D006801:Humans; D007858:Learning; D017145:Models, Educational; D061214:Patient Safety; D036301:Qualitative Research; D013338:Students, Nursing / Q000523:psychology*; D013548:Sweden; D013850:Thinking
keywords: Debriefing; High fidelity patient simulation; Learning; Nursing; Qualitative content analysis; Reflection