Enhancing Clinical Reasoning: Teaching Thinking Through Debriefing

Monday, 22 July 2013: 2:10 PM

Susan Forneris, PhD, RN, CNE, CRRN, CCM1
Diana Odland Neal, PhD, RN2
Mary Beth Kuehn, EdD, RN, PHN3
Jone Tiffany, DNP, MA, RNC4
Cynthia R. Pivec, MA, RN, CNE1
Lynnea Myers, MSN, RN, PHN, CPNP5
Linda Blazovich, DNP, RN, CNE1
Heidi Meyer, MSN, RN6
(1)Department of Nursing, St. Catherine University, St. Paul, MN
(2)Department of Nursing, Minnesota Intercollegiate Nursing Consortium, Northfield, MN
(3)Minnesota Nurses Consortium of Educational Research, St. Olaf College, Northfield, MN
(4)Department of Nursing, Bethel University, St. Paul, MN
(5)Nursing, Gustavus Adolphus College, St. Peter, MN
(6)Department of Nursing, Gustavus Adolphus College, St. Peter, MN

Learning Objective 1: The learner will be able to describe the use of the DML tool as a methodology for debriefing.

Learning Objective 2: The learner will be able to discuss the outcomes of the DML methodology and the implications for nursing education.


How nurses are educated to think in practice is receiving well-deserved attention calling for the need for innovative and transformative strategies that guide nurses in the use of nursing knowledge and science. Guiding thinking to assist novice nurses to better infer meaning and apply clinical reasoning across contexts is an important teaching strategy.  The overall purpose of this multi-site pilot study was to implement a debriefing strategy to determine its impact on clinical reasoning skills with undergraduate nursing students across four different colleges of nursing.  This study replicates Dreifuerst’s original study using a reflective debriefing model to enhance clinical reasoning.   


A quasi-experimental, pre-test-post-test, repeated measure, research design was used in this pilot study to evaluate student nurses’ clinical reasoning in simulation using the Debriefing for Meaningful Learning (DML) model. A convenience sample of 30 second year baccalaureate nursing students was the purposive, target population for this research. Students participated in a geriatric nursing simulation using the National League for Nursing’s (NLN) Advancing Care Excellence for Seniors (ACES) simulation scenario.  Clinical reasoning was measured through the Health Sciences Reasoning Test (HSRT).  


The original study findings illustrated statistical significance in the change in HSRT scores between pre-test and post-test. Results of the current study are being compiled and analyzed. It is anticipated that the findings will demonstrate a positive change in clinical reasoning skills with use of the DML debriefing model.  


Enhancing the effectiveness of teaching strategies that guide students thinking and clinical reasoning becomes clear – guide student thinking within the context of care.  Teaching thinking through reflection and debriefing has been shown to create a positive change in clinical reasoning skills.  Replication of these findings will support the utility of the reflective debriefing model adding to the nursing literature on effective teaching strategies that enhance clinical reasoning.