title: Contribution of a reflective debriefing to nursing students' clinical judgment in patient deterioration simulations: A mixed-methods study.
abstract: BACKGROUND
  While reflection is a hallmark of debriefing, there is little understanding of how it contributes to nursing students' clinical judgment.
  
  
  OBJECTIVE
  The aim of this study was to describe how nursing students perceived that the Reflective dEbriefing after a PatieNt Deterioration simulation (REsPoND) fostered learning and how it contributed to their clinical judgment in patient deterioration simulations.
  
  
  METHODS
  A sequential explanatory mixed-methods study.
  
  
  METHODS
  Nineteen students who showed the greatest clinical judgment score variation in a randomized controlled trial of the effectiveness of REsPoND.
  
  
  METHODS
  Students participated in interviews on their learning experience in REsPoND. Data were subjected to thematic analysis and themes were contrasted according to students' score variations.
  
  
  RESULTS
  Through guided exchanges with their peers, students configured a causes-observations-interventions framework that embodied their understanding of the patient's situation. They evaluated their own simulation performance based on that framework. The contribution of REsPoND to students' clinical judgment differed depending on (1) the value placed on the review of the simulation through a systematic assessment approach; (2) their focus on anticipating the situation or on performing in the simulation; and (3) their preference for who participated more in debriefing.
  
  
  CONCLUSIONS
  Clinical judgment might be improved when a systematic assessment approach is used to structure debriefing. The relationship between reflection and self-assessment during debriefing remains to be disentangled.
authors.affiliation: William F. Connell School of Nursing, Boston College, Boston, USA. Electronic address: patrick.lavoie.1@umontreal.ca.
authors.forename: Patrick
authors.initials: P
authors.lastname: Lavoie
authors.affiliation: Faculty of Nursing, Université de Montréal, Montréal, Canada. Electronic address: jacinthe.pepin@umontreal.ca.
authors.forename: Jacinthe
authors.initials: J
authors.lastname: Pepin
authors.affiliation: Faculty of Nursing, Université de Montréal, Montréal, Canada; Montreal Heart Institute, Montréal, Canada. Electronic address: sylvie.cossette.inf@umontreal.ca.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Cossette
mesh_terms: D002983:Clinical Competence; D004508:Education, Nursing, Baccalaureate; D000070856:High Fidelity Simulation Training / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D007600:Judgment; D008348:Manikins; D013338:Students, Nursing / Q000523:psychology*; D013850:Thinking
keywords: Clinical judgment; Debriefing; Mixed-methods; Nursing students; Patient deterioration; Plus-Delta; REsPoND; Reflection; Simulation