Pre-simulation and Prebrief
By now, you have drafted the outline and flow of your virtual gaming simulation storyline, including decision point questions, options, and feedback. With your outline complete, you can begin to structure the pre-brief component of the virtual simulation.
According to the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards Committee (2021) standards of best practice in pre-briefing, this component includes preparation and briefing. A clear and well-thought-out pre-simulation preparation and brief can create a safe and positive learning environment.
Pre-Simulation Preparation
Pre-simulation preparation occurs prior to the learners’ participating in the virtual gaming simulation and identifies theoretical content, as well as learning activities to help prepare learners to achieve the learning outcomes of the virtual simulation (Tyerman et al., 2016). The goal of the pre-simulation is to create awareness of the learner’s expectations and to help the learner obtain the required knowledge and skills to facilitate their learning experience. It also helps to identify gaps in their knowledge that should be addressed prior to playing the virtual simulation.
Pre-simulation preparation can include, but is not limited to:
- Class lectures and learning activities, including presentation notes, case studies, and concept maps.
- Lab skills, including practical skill checklist/guidelines, care plans, and assessment videos.
- Required readings focused on content, including textbooks, protocols, and best practice guidelines.
- Pre-simulation quizzes to assess knowledge and identify gaps.
- Self-reflective questions based on concepts addressed in the virtual simulation.
- Explain if any component of the virtual simulation will be graded (including due dates, guidelines, rubric) and any additional requirements (e.g., technology).
- Outline how to use the platform and how to play the virtual gaming simulation, including the website (e.g., learning management system or external website).
- Provide an orientation to the platform as needed.
(McDermott et al., 2021; Tyerman et al., 2019; Tyerman et al., 2016)
Virtual Gaming Simulation (VGS) Model
Scenario Synopsis
Reflecting back on the VGS Model scenario, below is a brief synopsis and potential pre-simulation preparation and pre-brief content that could be included for the learners:
Location: Medical Unit
Client Admission: Benjamin Diaz, a 53-year-old client whose pronouns are he/him. Admitted for acute exacerbation of chronic obstructive pulmonary disease (COPD). Increased coughing with pain, increased sputum production, increased wheezing and shortness of breath, and nausea for the last 48 hours prior to admission.
Medical History: Congestive heart failure, type 2 diabetes, hypertension, and anxiety. The client has seasonal allergies and has gained 20 lbs over the past year. The client smokes cigarettes and marijuana and started a smoking cessation program last month.
Social History: Primary school teacher, lives in Toronto with his partner. Currently they are renovating their home and “living through the construction mess.” Eating out more due to the kitchen renovations.
Last vital signs: RR 26, O2 saturation 90% on room air, Temperature 37.9 degrees Celsius (oral), HR 100, BP 138/84, BMI 26.4. VS q4h and PRN. IV saline lock in left hand.
MAR: on multiple medications.
Lab results: include blood work (CBC, PT, PTT, CMP), ECG, Urinalysis (Urea, Creatinine), Spirometry FEV1/FCV ratio, and pending chest x-ray.
Pre-Simulation Preparation
When determining the pre-simulation preparation, it is good to include a variety of teaching and learning strategies to help prepare learners in advance of playing the virtual simulation.
Sample Instructions:
Before you play the virtual gaming simulation on XX date, you want to maximize your learning experience by completing the following pre-simulation preparation activities to familiarize yourself with the content within the virtual simulation.
Sample List of Activities:
Theoretical Content
- Best practice guidelines: Canadian Lung Association, Gold Report, Heart and Stroke Canada, Hypertension Canada, Diabetes Canada
- Textbooks: Pathophysiology, Medical-Surgical, Communication, Medication Handbook, Laboratory Handbook, Nutrition
- Lecture: PowerPoint, modules, case studies and learning activities
- Institution-specific policies for practice placements
Skill Performance:
- Checklist and Guidelines: respiratory, cardiac, peripheral vascular, and integumentary assessment and interventions
- Medication calculations and preparation (oral, subcutaneous, intravenous)
- Communication: therapeutic (e.g., trauma-informed approach, health teaching), and professional (e.g., reporting to interprofessional team)
Reflections:
- Self-reflective questions on how to communicate and provide client centre care in an acute care situation
- Social determinants of health
Assessment and Evaluations:
- Pre-quiz on content based on virtual gaming simulation key learning outcomes
- Interactive modules on interpretation lab values, vital signs and chest x-ray results (e.g., using H5P interactive content)
When reflecting on your virtual gaming simulation, think about what pre-simulation preparation activities would help your learners to be successful in applying their clinical judgment and problem-solving skills during the virtual simulation scenario.
Prebrief
The pre-brief occurs just before the learners play the virtual gaming simulation and identifies the purpose and learning outcomes. The prebrief can be done in person or on the website platform if learners are playing the virtual simulation during their own time, outside of an assigned class.
The pre-brief can include, but is not limited to:
- Providing the purpose statement and learning outcomes of the virtual gaming simulation. Include a disclaimer if necessary, especially for sensitive content to inform the learner of what to expect and to remind them that the simulation is fictional.
- Outlining the virtual gaming simulation scenario.
- Explaining the role the learner will play within the virtual gaming simulation.
- Providing another opportunity for the learner to review how to use the platform. This may include who to contact for technical support or troubleshooting.
- Orienting the learner how to play the virtual simulation as needed. For example, how to move forward in the virtual simulation. This will be specific to the interactive game design elements your team chooses to use.
- Identifying the time needed to participate.
- Outlining what is expected from the learners regarding participation (e.g., prebrief, self-debrief and/or group debrief).
- Explaining the fictional contract in detail to foster psychological safety.
(McDermott et al., 2021; Tyerman et al., 2019; Tyerman et al., 2016, Verkuyl et al., 2021)
Virtual Gaming Simulation (VGS) Model
Prebrief
This occurs immediately before the learner plays the virtual gaming simulation and can be outlined in the introduction section on the online platform.
When reflecting on the VGS Model synopsis, the prebrief could include:
Sample Introduction:
Before playing the virtual gaming simulation, read the disclaimer note and review the purpose statement and learning outcomes. Once you have completed this step, proceed to the next slide which will identify your role, the client, healthcare environment, and introduction of the scenario. Then click “Proceed” to watch the first video of the virtual gaming simulation.
Sample Purpose Statement:
The purpose of this virtual gaming simulation is to assess and provide nursing actions/interventions including medication administration, to a client admitted to the hospital for acute exacerbation of chronic obstructive pulmonary disease (COPD).
Sample Learning Outcomes:
- Demonstrate clinical judgement assessing a client with acute COPD exacerbation.
- Analyze cues related to the client’s admitting diagnosis and medical history.
- Demonstrate knowledge and skills on safe medication administration.
- Prioritize nursing actions to manage a client with acute COPD exacerbation.
- Apply therapeutic communication skills when caring for an acute client.
For the VGS Model, the game will be hosted on Pressbooks and created using the H5P branching tool. Both of these features will be explained to the learner. Here’s an example from another game of what would be created:
- Introduction Page: https://pressbooks.library.ryerson.ca/pediatricvgs/chapter/chapter-1/
- Step by step guideline on How to Play the Virtual Gaming Simulation: https://pressbooks.library.ryerson.ca/pediatricvgs/wp-content/uploads/sites/287/2021/09/How-to-Play-the-Pediatric-Virtual-Gaming-Simulation.pdf
When reflecting on your virtual gaming simulation, what final instructions would you want to include in the pre-brief for your learners?
The prebrief component of the virtual gaming simulation design has multiple benefits.
Benefits include:
- Fostering psychological safety.
- Strengthening knowledge and skill performance.
- Decreasing anxiety.
- Improving confidence.
- Enhancing clinical judgement and problem-solving skills.
- Increasing learner satisfaction.
- Achieving learning outcomes.
(Badowski, 2022; Dale-Tam, 2021; McDermott et al., 2021; Tyerman et al., 2019; Tyerman et al., 2016; Verkuyl et al., 2021)
A well-thought-out pre-simulation preparation and prebrief can facilitate a supportive learning environment and help establish an environment for learner success when playing the virtual gaming simulation. Psychological safety is enhanced and fostered when the instructions and expectations are clear and concise.
Educator Tip
Preparation for the Virtual Gaming Simulation
It is beneficial to have a variety of teaching and learning strategies available for students to choose from to enhance their ability to participate in the pre-simulation preparation learning activities. Remember, the pre-simulation activities should be at the level of the learner and focus on how the learner can achieve the virtual simulation learning outcomes.
Additional Resources
International Nursing Association for Clinical Simulation and Learning (INACSL): Healthcare Simulation Standards of Best Practice™
The Healthcare Simulation Standards of Best PracticeTM Prebriefing provides guidance on the preparation and briefing stages of the prebrief.
The Healthcare Simulation Standards of Best PracticeTM Facilitation outlines key strategies on how to create a structured process for the participants’ learning and virtual simulation experience.
References
McDermott, D. S., Ludlow, J., Horsley, E., & Meakim, C. (2021). Healthcare Simulation Standards of Best PracticeTM Prebriefing: Preparation and Briefing. Clinical Simulation in Nursing, 58, 9–13. https://doi.org/10.1016/j.ecns.2021.08.008
Persico, L., Belle, A., DiGregorio, H., Wilson-Keates, B., & Shelton, C. (2021). Healthcare Simulation Standards of Best PracticeTM Facilitation. Clinical Simulation in Nursing, 58, 22–26. https://doi.org/10.1016/j.ecns.2021.08.010
References
Badowski, D., & Wells-Beede, E. (2022). State of prebriefing and debriefing in virtual simulation. Clinical Simulation in Nursing, 62, 42–51. https://doi.org/10.1016/j.ecns.2021.10.006
Dale-Tam, J., Thompson, K., & Dale, L. (2021). Creating psychological safety during a virtual simulation session. Clinical Simulation in Nursing, 57, 14–17. https://doi.org/10.1016/j.ecns.2021.01.017
McDermott, D. S., Ludlow, J., Horsley, E., Meakim, C., & INACSL Standards Committee. (2021). Healthcare simulation standards of best PracticeTM prebriefing: Preparation and briefing. Clinical Simulation in Nursing, 58, 9–13. https://doi.org/10.1016/j.ecns.2021.08.008
Tyerman, J., Luctkar-Flude, M., Graham, L., Coffey, S., & Olsen-Lynch, E. (2019). A systematic review of health care presimulation preparation and briefing effectiveness. Clinical Simulation in Nursing, 27, 12—25. https://doi.org/10.1016/j.ecns.2018.11.002
Tyerman, J., Luctkar-Flude, M., Graham, L., Coffey, S., & Olsen-Lynch, E. (2016). Pre-simulation preparation and briefing practices for healthcare professionals and students: A systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, 14(8), 80–89. https://doi.org/10.11124/JBISRIR-2016-003055
Verkuyl, M., Lapum, J. L., St-Amant, O., Hughes, M., & Romaniuk, D. (2021). Curricular uptake of virtual gaming simulation in nursing education. Nurse Education in Practice, 50, 102967–102967. https://doi.org/10.1016/j.nepr.2021.102967
