الفهرس 
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Abstract
Competent clinical performance is considered one of the essential attributes of the
nursing profession. The main aspect to graduating competent students is to introduce new
educational strategies that focus on decreasing the gap between theory and practice which
directly reflects on the student‘s performance. Reflective Debriefing Strategy (RDS) is
considered one of the main strategies that allow students to be self-directed in their
learning. They consider communication/exchange opinions and ideas with students about
their performance by using oral or written reflection, the students will expect to analyze
their actions and reflect on their cognition and psychomotor skills. Consequently, lead to
multiple benefits as enhancing students’ skills, and allowing them to learn from mistakes.
The instructors expand the conversation beyond technical errors and impact on learner
thought on professional development. Moreover, enables students to engage in the selfreview,
self-correct by assimilating a new experience with the prior ones. The RDS can be
conducted before /during or after the experience. So, the process of the RDS consists of
three phases which are; assessment and preparation, application, and evaluation of student
performance.
The assessment and preparation phase occurs before the conduction of the RDS.
Therefore, the educator should identify to what extent students can reflect and prepare
them well to recall and reflect easily and classify their feelings, thoughts related to the
experience. In the application of the RDS, the educator’s role is a facilitator; they ensure a
successful debriefing process and provide a supportive climate where students feel valued,
respected, and free to learn in a decent environment. Also, the educator may be loud and
quiet, big and small, active and still, slow and fast, silly and serious based on the
participant‘s assessment, and also based on the style of debriefing as a judgmental or nonjudgmental
approach. Reflection is the distinctive feature and core of the RDS. So, based
on the educator‘s assessment to students they decide to use the framework as a guide for
reflection. Kolb’s model of experiential learning portrays two dialectically related modes of
grasping experience which is: Concrete Experience and Abstract Conceptualization and
two dialectically related modes of transforming experience which are: Reflective
Observation and Active Experimentation. Therefore, students reassess their performance
several times in the RDS and plan how to enhance them until reaching their ideal
performance. Finally, the educator uses a Rubric to evaluate to what extent student reach
competency
This study aims to:
This study aims to determine the effect of reflective debriefing strategy on nursing
students‘ self-awareness, self-efficacy, and clinical performance.
Research hypotheses
Nursing students who are engaged in reflective debriefing strategy exhibit higher
self-awareness than those who are not.
Nursing students who are engaged in reflective debriefing strategy exhibit higher
self-efficacy than those who are not.
Nursing students who are engaged in reflective debriefing strategy exhibit higher
clinical performance in measuring blood pressure than those who are not.
Research design
A quasi-experimental research design was used.
Setting:
This study was conducted at nursing skills laboratories of the Medical-Surgical
Nursing Department at the Faculty of Nursing, Damanhour University where nursing
students were trained for their clinical procedures.
Subjects
The subjects of this study comprised 80 nursing students who were selected randomly
using simple random sampling to represent 220 nursing students who enrolled in the Medical-
Surgical Nursing Course -at the first semester of the academic year 2019-2020. The total
number of students was assigned randomly into two equal groups ”study and control” 40
students for each.
Tools of data collection
Four tools were used for data collection.
Tool I: Blood Pressure Evaluation Rubric
This observational Rubric was developed by the researcher after a thorough review
of related literature. It was used to measure the medical surgical nursing students’ level of
Bl. P performance.
Tool II: Blood Pressure Self-Efficacy Scale (BL.P SES)
This scale was developed by the researcher after a thorough review of related
literature. It was used to measure nursing students’ self-efficacy in performing blood
pressure procedure.
Tool III: Self-awareness Scale (SAS):
The self-awareness Scale was developed by (Ashley, 2008). It was modified by the
researcher to be applicable to assess the students’ understanding level regarding measuring
their self-awareness.
Tool IV: Reflective Debriefing Experience questionnaire (RDEQ)
The scale was developed by the researcher after reviewing the related literature. It
was used to determine students’ opinions about Reflective Debriefing Strategy.
The first part; contains fourteen statements related to the effectiveness of the
reflective debriefing strategy.
The second part; contains six statements related to the applicability of reflective
debriefing.
Method
Tools were tested for their content validity by five experts in the related fields and
their reliability was calculated.
A pilot study was carried out on 10 % of nursing students enrolled in the Fundamental of
the Medical-Surgical Nursing course to test the clarity and applicability of tools. The
tools were clear and applicable. Nursing students included in the pilot study were excluded
from the study subjects.
The reliability of the tools was tested using Cronbach‘s Alpha test .T. Tools were
reliable and their coefficient values were 0.846, 0.863, 0.887and 0.877respectively.
The study was conducted through three phases; preparation, implementation, and
evaluation phase.
I. Preparation phase
During this phase, the researcher, the content, and the students were prepared.
II. Implementation Phase
For the study group:
The researcher assessed students’ self-efficacy at the first session before the
demonstration of the blood pressure procedure.
The researcher conducted the sessions of Reflective debriefing after demonstration of
the procedure; using the following steps:
- Students were divided into 6 subgroups; each group contains 6-7 students with
considering reflective and non-reflective students in the same group.
- The researcher has explained the roles that should be carried out by students in each
subgroup
- Each student in each subgroup re-demonstrated the procedure Then reflected
individually on their performance in a written form
- The students and researcher discussed together to provide suggestions to enhance
the further performance of the procedure based on the strength and weakness in
the performance of each student; one hour was used for discussion. The
researcher’s role as a facilitator.
- Whats-App as a social network platform was used to enable the students to exchange
information with each other, and with the instructor. It was also used to discuss their
reflection about performing blood pressure at home.
Control group:
The control group was left to the routine of Medical-Surgical Nursing Department
strategy in teaching the blood pressure. As the instructor demonstrates the procedure
was followed by students‘ re-demonstration of that procedure.
Self-efficacy tool was distributed to nursing students before re-demonstration of the
procedure
Phase III: Evaluation phase
For both groups; Researcher evaluated students‘ performance and self-efficacy
For study group:The effectiveness of the debriefing sessions was evaluated by
using a debriefing experience scale (DES); Tool III.
The main results obtained were as follows:
Concerning the socio-demographic characteristics of the subject. It was observed that
75% of students in the study group compared to 72.5%of them in the control group
were females, whereas 25.0% of the students in the study group were male compared
to 27.5% of them in the control group. Moreover, three-quarters of students in both
groups were from a rural area. The age of more than half of the students in both
groups ranged from 18 to 19 years.
97.5% and 100.0% of the students in the study and control groups were enrolled in
the academic semester for the first time respectively.47.5% of the student had
hobbies in the study group compared to17.5% of them in the control group.
Concerning students‘ Blood pressure self-efficacy There was not a statistically significant
difference between the study and control groups about their Blood pressure self-efficacy
before applying RDS (1.607 p=0.302) Whereas, a highly statistically significant difference
was found immediately after applying RDS (76.400* p<0.001*). On the other hand, there
was a significant difference between pre and post-application of RDS in relation to the
study group (p=<0.001*). Whereas, There was no significant difference between pre and
post-application of RDS in the control group (p=0.763).
Regarding students‘ self-awareness there was a statistically significant difference
between the study and control groups’ self-awareness before applying RDS 2 =
9.038*(0.003*). in addition, a statistically significant difference was found
immediately after applying RDS 2=69.001*(<0.001*).On the other hand, there was a
significant difference between in pre and post-application of DDS in relation to the
study group (p<0.001*) Whereas, There was no significant difference between pre
and post-application of RDS in relation to the control group (p=0.508)
There was a statistically significant difference between the study and control groups’
clinical performance immediately after the application of RDS,χ2=44.598*
(MCp<0.001*). Also, a statistically significant difference was found 8 after applying
RDS χ2=27.659* (MCp<0.001*).On the other hand, there was no significant difference
between the performance of students immediately and after 8weeks of the application
DDS in relation to the study group as the Mean ± SD was 23.73± 0.28, 23.61 ± 0.65
respectively. Moreover, There was no significant difference immediately and after
8weeks of application DDS in relation to the study group as the Mean ± SD
was19.30±2.42,19.37 ± 4.54.
A positive statistically significant correlation was found between the study group
students‘ clinical performance and their self-awareness immediately after applying
RDS (p = 0.570*). Moreover, a positive statistically significant correlation was
detected between the study group students’ clinical performance and their selfefficacy
(p 0.476*).
In relation to the effectiveness of the reflective debriefing 100.0% of students agree
that RDS improved their self-evaluation; realized the value of reflection on their
performance, enabled them to analyze their performance, retrieved what they learned
and did, identified their weaknesses, expressed themselves, improved their thoughts,
became more aware of their strength about skills, identified their own learning needs,
improved their observation skills reflect on any task.
Concerning Reflective Debriefing Strategy applicability, it was noted that all of the
students agree that RDS was productive and fruitful and they felt competent during
the application of strategy. The majority of students agree that they did not find
founded difficulties in reflection on their performance, the environment was
comfortable, satisfied toward the application of strategy and the instructor provide
suitable guidance.
Conclusion
It can be concluded from the current study that Reflective Debriefing Strategy (RDS)
is a valuable teaching strategy. It played a crucial role in enhancing Medical-Surgical
nursing students’ self-awareness, clinical performance, and efficacy in performing blood
pressure procedure. RDS was perceived by Medical-Surgical nursing students as a selflearning
teaching method and learned new ways of thinking and learning, enabled them to
analyze their performance. Also, it developed their evaluation, critical thinking,
observation, and judgment, and communication skills.
The following recommendations are suggested based on the results of the study:
Recommendations related to nursing education
Educational workshops should be conducted for all nurse educators to enhance the
awareness about how to write and think reflectively.
Educational workshops should be conducted for all nurse educators to enhance the
awareness about the RDS.
Reflective Debriefing strategy should be used in combination with traditional clinical
teaching methods.
The curriculum schedule should support RDS to enable the educator to provide
sufficient time for students to process their recalled learning
Reflective questions should be introduced in all nursing/non-nursing courses at the
Faculty of Nursing, Damanhour University.