The simulation sessions were conducted with 27 third-year nursing students; three of them were Norwegian students participating in a student exchange programme. Three scenario sessions, with eight to nine students in each session, were carried out in 1 day. The simulation sessions took place in the skills training and simulation centre in the nursing school. Two different scenarios were selected: (1) a patient case concerning postoperative care and (2) a patient case concerning sepsis in the emergency room.
Overall, the simulation method was new to the Tanzanian students and teachers; therefore, the Tanzanian teachers observed, while the Norwegian teachers facilitated the simulation sessions. The Norwegian nursing students had participated in simulation-based education sessions in Norway; however, this was their first simulation session together with the Tanzanian nursing students. To reduce anxiety and create a relaxed atmosphere, each session began with the facilitator briefly explaining that the simulation sessions were not graded and that the experience was about learning. The learning outcomes in both scenarios included the students conducting a primary survey of the patient, implementing relevant nursing interventions and working as a team. Descriptions of the patient’s case, learning outcomes and basic nursing equipment, such as blood pressure (BP) cuffs, intravenous (IV) lines and stethoscopes, were presented to the students during the briefing phase. In each case, one student played the role of the patient and was instructed about how to act in the scenario. Three students participated in the scenario as nurses, while the rest of the group observed the simulation session. In the sepsis scenario, one student also acted as a relative of the patient. The observers were all presented with specific objectives to look for. One group observed how the primary survey was conducted, and the second group looked at the communication and collaboration during the simulation. Each scenario session lasted approximately 10–12 min, followed by a debriefing session lasting for about 30 min.
The debriefing phase started with the students describing what happened during the scenario. This was followed up with the analytical phase, in which the students were asked what was successful in the scenario and why, and what could have been improved. In the last phase of the debriefing session, the students were asked to express what they had learned during the simulation session and how they could transfer this knowledge into clinical practice. We carried out the debriefing phase based on our long existing “good practice” in simulation-based education. Multiple theoretical debriefing methods exist , and when we retrospectively reflected on our debriefing methodology, we learned that our practice was aligned with Arora et al.’s objective structured assessment of debriefing .
To strengthen the learning outcomes, the same scenario was run twice, with those students who actively participated in the scenario the first time, playing the role of observers the second time. After the simulation session, the students were asked to complete a faculty-derived evaluation form describing what they learned in the simulation session, whether the simulation helped them acquire skills useful for clinical practice, what they liked about participating in the simulation sessions and what they thought of the simulation scenarios.