Reflection-in-action during high-fidelity simulation: A concept analysis
Introduction
High-fidelity simulation is a widely used teaching modality in healthcare, aviation, nuclear power, business, military, education, and police training (McMullen et al., 2016; Rutherford-Hemming, 2012; van den Heuvel et al., 2014). This broad utilization of high-fidelity simulation may be attributed to its effectiveness in promoting learning through active hands-on experience in a risk-free environment; while promoting teamwork, communication, and the development of critical thinking skills (Maran and Galvin, 2003; Mayville, 2011). Despite high-fidelity simulation being utilized for hands-on experiences, experience alone does not result in learning. Rather, learning happens through reflection. Ideally simulation educators, who use high-fidelity simulation, have adequate training and knowledge to support students in reflective practice (Sawyer et al., 2016).
Boyd and Fales (1983) defined reflection as “the process of creating and clarifying the meaning of experience (present or past) in terms of self” (p. 101). Schön (1987) further studied the area of reflective practice, discussing the importance of “reflection-before-action…reflection-in-action…and reflection-on-action” (p. 34), which can be simplified into reflecting on actions in the future, present, and past, respectively. Debriefing is considered the essential step to learning in high-fidelity simulation, therefore the literature on high-fidelity simulation focuses heavily on the later reflection-on-action through debriefing (Kang and Yu, 2018; Ha, 2020; Zhang et al., 2020). However, the literature is starting to shift to include a focus on reflection-before-action, and the importance of pre-briefing in high-fidelity simulation (Chamberlain, 2017; Page-Cutrara, 2014; Page-Cutrara and Turk, 2017). Although Schön (1987) believed in the importance of reflection-before-action and reflection-on-action, he thought the hallmark of mastery or artistry of a subject depended upon an individual's ability to reflect in the moment (reflect-in-action). In this process, knowing moves beyond what is tacit, and individuals can make changes to their actions during the event. Educators can support students to engage in reflection-in-action to help them develop the mastery and artistry of nursing.
Our purpose in writing this paper is to provide an in-depth analysis of reflection-in-action during high-fidelity simulation-based learning. We sought to identify what is currently known about the topic and establish a strong foundation or building blocks for theory development regarding cultivating reflection-in-action during high-fidelity simulation. In this paper, we define the concept of reflection-in-action and identify the key attributes, antecedents, consequences, cases, and empirical referents of this concept, using Walker and Avant's (2011) framework.
Section snippets
Methods
Walker and Avant's (2011) approach to concept analysis is a well-used framework in nursing literature on high-fidelity simulation (Bland et al., 2011; Cohen and Boni, 2018; Sabei et al., 2016; Turner and Harder, 2018), and is often used to guide comprehensive concept development and clarify ill-defined concepts. This framework consists of an eight step approach: 1) selecting the concept; 2) determining the purpose of the analysis; 3) discovering all uses of the concept; 4) determining the
Results
Our search yielded 296 articles, spanning 1998–2019. The abstracts were reviewed; articles that did not focus on high-fidelity simulation or reflection-in-action, and duplicate articles were removed. This left 117 articles that were reviewed in full text for potential inclusion. After excluding articles that did not focus on high-fidelity simulation, or reflection-in-action, we were left with 22 articles that met our inclusion criteria. Table 1 provides an overview of the results.
Discussion
Educating reflective practitioners is a goal of higher education. Every interaction with students must be considered an opportunity to form knowledge and develop reflective practitioners (Bloom, 1971; Kwan and Leung, 2006). This concept analysis of reflection-in-action during high-fidelity simulation education provides valuable insights for nursing educators and researchers. The defining attributes, antecedents, and consequences as well as the case examples may guide nursing educators to
Conclusion
In this paper we define the concept of reflection-in-action during high-fidelity simulation as the moment within high-fidelity simulation in which students are challenged to demonstrate their knowledge and skills beyond mechanical action. It is the point at which students bridge didactic learning and clinical practice, gaining understanding, new skills, flexibility, speed, and self-confidence. Simulation educators should have a strong understanding of how to identify when and encourage students
Funding source
Not applicable.
Ethical approval
Not applicable.
Declaration of competing interest
None declared.
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2022, Nurse Education TodayCitation Excerpt :However, reflection-in-action should be caught during the simulation or the true reflective process may be lost (Clapper and Leighton, 2019; Mulli et al., 2021). Being able to reflect in the middle of a situation has been suggested to be a critical skill for nursing practice, therefore, undergraduate nursing simulation facilitators need to be able to identify and support students to reflect-in-action (Mulli et al., 2021). Benefits to reflection-in-action include learners performing new actions; being able to adapt and improvise; gaining understanding or new knowledge; feeling secure; and increased self-confidence (Clapper and Leighton, 2019; Hughes and Scholtz, 2015; Kihlgren et al., 2014; McMullen et al., 2016).
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