By: Mary Cato, EdD, RN
It has been five years since the NLN, in collaboration with INACSL (the International Nursing Association for Clinical Simulation and Learning), published Debriefing Across the Curriculum. While it is accepted that debriefing in simulation has an impact on learning and is, in fact, the most important aspect of the simulation experience, this Vision Statement challenges us to ask: How exactly can we transfer the principles of debriefing to other learner settings?
Helping learners reflect on their actions and the thought processes that guide them is a key element of debriefing. This practice transfers well to clinical, classroom, and online environments. In clinical, in particular, instructors have opportunities to discuss events with students with the intention of facilitating learning. Most of us would say we have been doing this all along, and most of our students would agree. Coaching has the potential to be even more effective when done consistently and according to a defined plan. Students can expect that certain relevant questions will be asked and that their interactions, decisions, and interventions will be explored in order to increase understanding and foster learning. Knowing what to ask and how to ask it are skills that every expert teacher ought to have.
Eppich et al. (2016) state that coaching “incorporates the coach’s own observations and perspectives on specific matters” and that it “may involve confirming or challenging learners’ self-assessment of their own performance by providing effective feedback and focused teaching.” They discuss the importance of supportive clinical learning environments and the conversations that take place within them. Dyess et al. (2017) discuss the evolution of coaching as a skill that could impact patient care and the environments in which care takes place. Critical thinking and theory are essential to coaching, and there is an art to it as well that “involves creating the space for coaching to occur through asking open-ended reflective questions and listening actively” (p. 374).
In Critical Conversations: The NLN Guide for Teaching Thinking, Forneris and Fey (2018) encourage educators to examine their relationships with learners and engage in critical conversations with them about nursing practice. They offer a framework (i.e., NLN Guide for Teaching Thinking) for these interactions and provide examples of questions to encourage thinking. In addition to asking the right questions at the right time, faculty may need to assist students in receiving coaching or feedback. Beroz (Teq blog, August 2018) provides some insight into how people receive feedback, coaching, and evaluation.
As clinical teachers develop skills in coaching, it is helpful to keep in mind the attributes of our current learners in nursing programs, as well as nurses in their early years of practice. Although labeling a generation and making generalizations about attributes is not always helpful, it is indisputable that the world we inhabit impacts our lives to some degree. Millennials (most often defined as those born between 1981 and 1996) represent a large segment of the current nursing student population, with Generation Z, those born between 1997 and 2012, also among that group. Historical events during these years have impacted how our learners react and respond to our teaching. Many lists of millennial characteristics include references to the desire for work to have meaning. Millennials have been described as wanting to be coached to build their strengths and openly receptive to feedback and recognition. Included in traits of Generation Z are undeveloped social and relationship skills and short attention spans. Chicca and Shellenbarger (2018) suggest that modeling skills such as active listening and constructive criticism may be helpful. Again, being cautious of broad generalizations, providing a nurturing environment and prompt feedback can certainly be helpful interventions for these groups.
Many faculty who use simulation are familiar with the process of prebriefing, in which the purpose and expectations of simulation are explained. It may be helpful in clinical and even classroom environments to do the same with coaching. This might involve a discussion with the group, in advance, about the conversations that will happen in their learning environments. Identifying for students what coaching will look like, and what questions you may ask (and why), may ease their anxiety and prepare them to think about and plan their clinical care. The NLN course Coaching for Excellence provides video examples and opportunities for practice in having coaching conversations with students. Increasing our skills in teaching students how to think can only improve nursing practice and health care environments in the future. A new edition of the Forneris and Fey book, Critical Conversions, is due out in the fall.
References
Beroz, S. (2018). The receiver of feedback and simulation pedagogy. Teq blog. https://nlnteq.org/2018/08/01/the-receiver-of-feedback-and-simulation-pedagogy/
Chicca, J., & Shellenbarger, T. (2018). Approaches and teaching-learning practices for nursing professional development practitioners. Journal for Nurses in Professional Development, 35(5). doi:10.1097/NND.0000000000000478
Dyess, S.M., Sherman, R., Opalinski, A., & Eggenberger, T. (2017) Structured coaching programs to develop staff. Journal of Continuing Education in Nursing, 48(8), doi:10.3928/00220124-20170712-10
Eppich, W.J., Mullan, P.C., Brett-Fleegler, M., & Cheng, A. (2016). “Let’s talk about it”: Translating lessons from healthcare simulation to clinical event debriefings and clinical coaching conversations. Clinical Pediatric Emergency Medicine, 17(3) . doi:10.1016/j.cpem.2016.07.001
Forneris, S.G., & Fey, M. (2016). Critical conversations: The NLN guide for teaching thinking. Nursing Education Perspectives, 37(5), 248-249.
Forneris, S.G., & Fey, M. (Eds.) (2018). Critical conversations: The NLN guide for teaching thinking. National League for Nursing.