The Effect of Hot and Cold Debriefing on BLS Competence and Reflection in Undergraduate Nursing Students

Abstract

Background: Cardiac arrest is one of the leading causes of death globally. Each year, the number of out-of-hospital cardiac arrests in the US exceeds 356,000. Nearly 90% of them are fatal. Basic Life Support (BLS) is an essential element in simulation experiences for nursing students. In simulation training, debriefing is one of the essential tools recommended following cardiopulmonary arrest events. Although AHA recommends debriefing for BLS, debriefing is still delivered in hot format or not delivered at all. In a well-structured simulation experience, debriefing is essential to the learning process. Debriefing improves the performance of individuals, teams, and systems. In the literature, "hot" debriefings occur within minutes to hours of the simulation, whereas "cold" debriefings can occur within days to weeks. There is still a lack of evidence about the best debriefing methods for undergraduate nursing students. Purposes: Manuscript 1 aimed to identify the uses, advantages, and disadvantages of hot and cold debriefing in a nursing context. Guided by Kolb's experiential learning theory (ELT), a two-phase was designed. Phase one (manuscript two) aimed to identify the efficacy of cold versus hot debriefing in Basic Life Support (BLS) training for undergraduate nursing students' BLS competence and to assess the impact of hot versus cold debriefing on undergraduate nursing students' debriefing experience. Phase 2 (manuscript three) explored undergraduate nursing students' experience with cold and hot debriefing styles. Method: The study consisted of two phases. Phase one was a randomized controlled trial. The students were randomly assigned to a control or experimental debriefing condition. A total of 44 students participated in phase one. Twenty-two students were in the experimental group (Cold), and 22 were in the control group (Hot). Phase two involved collecting qualitative data through two focus group interviews. Twelve students participated in phase two, six in each group. Results: In manuscript one, twenty articles met the inclusion criteria. Due to heterogenicity in the studies' design, debriefing tools, methods, and intervention fidelity across the reviewed studies, it was difficult to draw a strong conclusion on the effect of hot versus cold debriefing. The result of this integrative review formed the scientific basis of the next two manuscripts. In manuscript two, both the hot and the cold debriefing groups significantly improved their BLS competence scores from the pre- to the post-test. The results revealed no statistical differences between the two debriefing methods regarding BLS competence scores and debriefing experience scale scores between the hot and cold debriefing groups. Qualitatively (manuscript three), Five main categories emerged from students' perceptions related to simulation and debriefing experiences: Simulation Experience, Debriefing Experience, Reflection, Debriefing Impact on Learning, and Advice for Educators. Conclusions: It is recommended that simulation followed by debriefing be integrated into the nursing curriculum, especially for teaching BLS. The study emphasizes the value of debriefing in simulation-based education and offers insights into optimizing debriefing strategies to improve nursing experiences and competence. Although there was no statistically significant difference between the two debriefing methods, it was evident that simulation with both debriefing approaches were beneficial. There are advantages and disadvantages to each type of debriefing, and the choice may need to be tailored based on the specific situation.