problem solving process requires instruction on error recognition, error recovery and error avoidance. Using this principle of instruction during guided reflection may enhance learning from the clinical scenario.
Providing enhanced guidance to designers and faculty regarding learner preparation and guided reflec-tion and feedback may be accomplished by referring to other currently available models. The approach to de-briefing proposed by Rudolph, Simon, Dufresne, and Raemer (2006) includes both student preparation and debriefing. Dreifuerst (2009) has also proposed a com-prehensive framework for debriefing that includes re-flection, emotion, reception, integration, and assimila-tion/accommodation. The designer and faculty could overlay one of these models of debriefing while main-taining a focus on the course objectives.
Expanding the model to consider others present would assist designers develop roles in addition to the primary nurse and would help faculty implement learn-ing activities for students who may be required to ob-serve the simulation. There is little literature on the topic of observer engagement. However a case report by Kalmakis, Cunningham, Lamoureux and Elshaymaa (2010) demonstrated that student observers who were provided with a case-specific observation sheet demon-strated engagement in a clinical scenario enacted by peers in a simulation laboratory. Further exploration of techniques to assure engagement of observers would be beneficial to faculty who manage larger groups in simulation environment.
The Jeffries model would also be strengthened by clarifying the interrelationships between the design characteristics. Based on the results of this study, a direct relationship between objectives, problem solv-ing, and debriefing was found; objectives directly in-fluenced the design of the problem solving situation and both objectives and student problem solving be-haviors informed the structure of debriefing. The de-