Barriers and enablers to learning during team-based clinical simulations: Reflective interviews with final year undergraduate nursing students

Background: Contemporary approaches to clinical simulation can enhance educational outcomes. However, simulation
approaches do have limitations with possible compromises for learning and teaching. This paper aims to identify barriers
and enablers to learning in simulated clinical settings.
Methods: A generic qualitative design was applied. Semi-structured group video debriefing interviews were held with
Australian final-year nursing students who completed three patient deterioration scenarios with a standardized patient.
Audio-recorded interviews were transcribed and analysed to identify emergent themes.
Results: Interviews with 15 teams of three students (n = 45) from three universities were analysed. Learning enablers were
‘Realism of the simulated environment’; ‘Practicing: we should do this at uni’; ‘Learning from reflection and expert
feedback’, and ‘How to become competent: know the gaps’. Barriers to learning included ‘Increased stress from
inexperience; ‘Expectations when pretending’ and ‘Lack of assistance’. Skills practice in team-based settings with
applicable reflection and debriefing was regarded as beneficial. Simulated patients enhanced fidelity but were unable to
replicate actual clinical signs. High stress levels were perceived as a barrier to learning.
Conclusions: Applicably designed high fidelity simulations with video-based reflective review offer repeated rehearsal of
clinical situations to enable learning. This educational strategy may reduce the time it takes undergraduate students to
reach competency.