Debriefing has been used to encourage learners to reflect on their practice and to identify learning gaps without the pressure of being formally evaluated. Like debriefing, concept mapping can be easily implemented in classroom settings to help students enhance their learning experiences, promote critical thinking, and interpret information more clearly (Samawi, Miller, & Haras, 2014). This article reports on how the use of concept mapping during debriefing related to an increase in active learning by analyzing thoughts and making connections to clinical concepts. Two main outcomes were measured: 1) Analyzing Thoughts and Feelings and 2) Learning and Making Connections to Clinical Concepts.
RELEVANCE AND BACKGROUND
Bandura's (1977) theory of observational and social learning was used as the theoretical framework for this pilot study. Bandura explained that analysis of one's assumptions when observing others can help learners think critically about alternative actions they can implement in the future. Participating and observing others create concept maps is a helpful teaching strategy that promotes active learning, critical thinking, and the conceptual interpretation of information. Samawi et al. (2014) claimed that concept mapping has a positive application within nursing education, helping students make connections between theoretical and clinical concepts. Furthermore, studies in the social sciences and health care have shown that the use of concept mapping promotes meaningful learning, increases critical thinking abilities, and enables educators to assess students' understanding of educational content (Canasi, Amyot, & Tira, 2014; Hagell, Edfors, Hedin, Westergren, & Hammarlund, 2016; Korganci, Miron, Dafinei, & Antohe, 2014). Taylor and Wros (2007) claimed that concept mapping helps nursing students better process information for developing nursing care plans. For these reasons, the use of concept mapping to guide debriefing has the potential to enhance understanding of connections between clinical concepts and nursing practice.
METHOD
The Debriefing Experience Scale (DES) is a reliable instrument with Cronbach's alphas of .93 for all items in the scale area of experience and .91 for all items in the scale area of importance. The DES was validated in previous studies by nationally known experts in simulation as well as through a two-step factor analysis process (Reed, 2012). This 20-item instrument is categorized into four subscales: 1) Analyzing Thoughts and Feelings, 2) Learning and Making Connections, 3) Facilitator Skill in Conducting the Debriefing, and 4) Appropriate Facilitator Guidance (Reed, 2012). Analyzing Thoughts and Feelings and Learning and Making Connections aligned best with the focus of this pilot study.
Reed (2012) explained that, during debriefing, learners can highlight significant areas for self-improvement that may be helpful to their own practice. Moreover, learners can use this sort of analysis and feelings to promote the type of learning that aids in the connection to clinical concepts. Because the Debriefing Experience Scale has been used in previous studies and was reliable in assessing the debriefing experiences of learners (Reed, 2015; Royle, 2014; Tosterud, Petzall, Wangensteen, & Hall-Lord, 2015), we determined that its use in this study was justified to assess participants' experiences.
Institution research ethics board approval was obtained for this pilot study. The population approached to participate was 42 students enrolled in their last year of the nursing program. This level of student was appropriate as participants would not have difficulty creating concept maps or knowing how to participate during a debriefing session. A recruiting announcement was sent to eligible students with information about the study and when to meet with the researchers to ask questions and provide informed consent. Participants were randomly assigned to a study group, 17 to the experimental group (debriefing guided by a concept mapping activity) and 17 to the control group (traditional debriefing group discussion).
After observing a 20-minute video that depicted nurses caring for a medical-surgical patient with respiratory distress, both groups engaged in a 50-minute debriefing session conducted by experienced facilitators. Experimental group participants, divided into two groups, were asked to create a concept map that traced the clinical events observed in the video. The facilitator selected key concepts captured in the students' maps to initiate the debriefing process. Participants were asked to compare their maps and speak to the subtle similarities and differences between them. At the end of the sessions, participants completed the DES.
RESULTS
Of a possible 42 participants, 34 students agreed to participate for a response rate of 80 percent, the expected response rate for this pilot study. Why some students decided not to participate is unknown. An independent samples t-test was conducted to examine whether the means of the subscales of Analyzing Thoughts and Feelings and Learning and Making Connections were significantly different between the control and the experimental group. The subscale of Analyzing Thoughts and Feelings was significant, t(26) = -8.17, p < .001, suggesting that the mean was significantly lower in the control group (M = 12.69) than in the experimental group (M = 18.53). The results for Learning and Making Connections were also significant, t(26) = -5.08, p < .001, suggesting that the mean was significantly lower in the control group (M = 30.15) than in the experimental group (M = 34.47).
DISCUSSION AND IMPLICATIONS
This pilot study used observational and social learning (Bandura, 1977) as a framework because students can learn from the examples and actions of others during their time of debriefing. In addition, the DES was used to measure participants' perceived learning experiences while using concept mapping as a form of active learning and to guide the debriefing discussions. Therefore, concept mapping helped nursing students engage in active learning and critical thinking more so than passively engaging in group discussion. Moreover, students used their concept maps to discuss with each other the meaningful connections made between clinical concepts. Previous studies have looked at concept mapping to plan the actions of learners during high-fidelity simulation (Samawi et al., 2014). Similarly, Dreifuerst (2015) suggested the use of concept mapping in Debriefing for Meaningful Learning as an optional aid in the debriefing process and to help learners experience meaningful levels of reflective practice.
Although previous studies have proven a positive use of concept mapping for enhancing the experience of reflective practice, this pilot study attempted to investigate how students use concept mapping to guide the debriefing process, make meaningful connections to clinical concepts, and learn from such connections. We found that, by adding concept mapping to the time of debriefing, students were more focused and actively engaged in the processes of reasoning, critical thinking, and making connections to clinical concepts.
This study had some limitations, including the small sample size and a convenience sample from one institution. Further research with a larger sample from multiple sites and using qualitative approaches can assess students' comfort using concept mapping and help generalize the effectiveness of connections to clinical concepts that concept mapping can provide.
The findings in this pilot study can inform the teaching practice of nurse educators, supporting the use of concept mapping to guide the debriefing process and promote active participation during debriefing. With the use of concept maps, nurse educators can infuse theoretical concepts from areas of pathophysiology, pharmacology, and nursing implications, thereby influencing students' ability to think critically while reflecting during debriefing. Concept mapping during the reflective process in debriefing can help educators assess students' understanding of clinical concepts and their relationship to present and future nursing practice. Scaffolding of learning through concept mapping can provide theoretical and instructional support during the debriefing experience so that deeper levels of learning may be achieved. Finally, the use of concept mapping as a teaching strategy during debriefing can support the psychological safety of learners and promote a positive and student-centered learning environment.
REFERENCES