In this study, we created case videos for debriefing based on the results of an open-ended questionnaire survey and focus group interviews among nursing students. The topics of the case videos were newborn assessment methods, interpretation of results, and basic assessment data, including aseptic techniques. Practical educational materials were created after analyzing the needs of nursing students, who were the intended audience of the materials. A study on educational needs for practicing neonatal intensive care among nursing students [27] also demonstrated a high level of educational needs for newborn assessments, reflecting the importance of accurately assessing high-risk newborns in the NICU. In other words, when conducting a simulation of high-risk neonatal care, nursing students should be instructed to be fully aware of the methods for accurately assessing and interpreting the condition of a newborn baby.
The experimental group that participated in the case video-based debriefing developed in this study showed a greater improvement in critical thinking than was observed in the control group. In the focus group interviews with the experimental group, participants reported that they were able to understand nursing activities more easily and accurately by watching case videos and that they were able to engage in detailed discussions and feedback because they remembered their own behavior. A previous study [28] also reported that videos provided nursing students with an opportunity to review what they had done and helped them reflect on their actions. Furthermore, it was also reported that videos increased nursing students’ ability to access materials for learning clinical skills [29]. In our study, case video-based debriefing enabled nursing students to identify mistakes they had not previously thought of and recognize new solutions, and the students thought that they make fewer mistakes in the future. In other words, using case videos in the debriefing stage made learning clearer and more comprehensive, resulting in improved critical thinking among the nursing students.
Satisfaction with practice also showed a greater increase in the experimental group also improved more markedly than that of the control group. Based on the focus group interviews with the experimental group, case video-based debriefing created a comfortable learning atmosphere. Conducting the debriefing while watching one's own and colleagues' simulation made students nervous about being evaluated by their instructors and peers and put them in the stressful social situation of having to evaluate their peers. This is consistent with a previous report [16] where the study participants felt nervous and stressed about recording a simulation. However, debriefing using case videos filmed as substitutes for analyzing their own and their team members’ actions helped them feel psychologically safe and introspect objectively without experiencing those tensions. This objectivity reduced unnecessary emotional stress and increased learners’ satisfaction with practice by allowing them to focus on the wrong action itself rather than the person who did something wrong.
However, self-efficacy and state anxiety were not found to differ over time between the experimental group and the control group. The self-efficacy of the control group did not change in the pre- and post-survey, and the self-efficacy of the experimental group increased in the post-survey compared to the pre-survey, but not to a significant extent. Self-efficacy refers to the belief that one can solve a problem by taking appropriate action in a specific situation [20]. Since psychological characteristics such as self-efficacy take a long time to form and change, ongoing education programs should be provided, and studies should evaluate their long-term effects.
In addition, there was no significance difference in state anxiety over time between the two groups, since state anxiety decreased from the pre-survey to the post-survey in both the experimental group and the control group. Nursing students who are about to take a practicum and simulation often experience anxiety, worrying about whether they will be able to do their job well without making mistakes. As state anxiety measures the present anxiety felt in a specific situation [22], it tends to be high just before a given task and the decrease after the task is finished. Accordingly, it is reasonable that state anxiety decreased after the end of NICU practice in both groups. Therefore, it would be more appropriate to closely explore participants’ emotional states while participating in case video-based debriefing, and to do so, we also collected qualitative data in this study. The qualitative analysis confirmed that the experimental group comfortably immersed themselves in learning, free from stress about evaluation. In other words, debriefing using case videos provided nursing students with a comfortable learning atmosphere and facilitated learning.
In summary, this study developed case video-based debriefing materials for a simulation of high-risk neonatal care, and the experimental group took part in case video-based debriefing. Case video-based debriefing on a high-risk neonatal care simulation effectively improved nursing students' critical thinking and satisfaction with practice. The use of case video-based debriefing will help nursing students become more proficient at providing high-risk neonatal care.
Nonetheless, there are several limitations to this study. First, nursing students from a single nursing college were recruited through convenience sampling, so its findings should be interpreted with caution. Second, in order to prevent the spread of the experimental effect, the experimental group and the control group were assigned according to the practice period; thus, random assignment was not performed. There were no significant differences in homogeneity testing of the general characteristics and dependent variables of the experimental group and the control group before the intervention, but a randomized controlled study is needed in the future. Third, despite our efforts to produce videos that matched the simulation situation, the video content had certain limitations. In particular, participants reported that it was difficult to concentrate on videos that did not exactly match their behavior. In the future, it will be necessary to develop videos of a broader range of cases and improve the video data. Fourth, only one posttest in this study was administered following the intervention, and no follow-up tests were administered to confirm the long-term effect of case video-based debriefing. In the future, follow-up studies should be carried out to confirm the intervention's long-term effects.