Reflection-in-action during high-fidelity simulation: A concept analysis.

Objectives: Our primary aim was to complete an in-depth analysis of the concept of "reflection-in-action" during high-fidelity simulation. We sought to identify what is currently known about the topic and establish a strong foundation for theory development regarding cultivating reflection-in-action during high-fidelity simulation.

Design: Walker and Avant's (2011) systematic approach to concept analysis was used as a framework to develop a comprehensive understanding of reflection-in-action during high-fidelity simulation.

Data Sources: We conducted a review of literature on reflection-in-action (with open date parameters) in PubMed, Eric, PsychInfo, ABI/Business Premium Collection, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) electronic data bases using key terms "reflection-in-action" AND "simulation". In addition, we hand-searched reference lists from key articles in the journals Simulation in Healthcare, Simulation and Gaming, and Advances in Simulation.

Results: Our search resulted in 22 articles, from 1998 to 2019, that met the inclusion criteria. Four defining attributes of the concept were identified: (1) reflection-in-action must occur during high-fidelity simulation and cannot be captured within post-simulation debriefing; (2) a critical learning juncture must occur and be identified by the learners; (3) a pause in student action must occur during the high-fidelity simulation; and (4) knowledge sharing must occur through out-loud discussion. Antecedents, consequences, and empirical referents of reflection-in-action were also identified.

Conclusions: The insights from this review may enhance the ability of nursing educators to effectively support reflection-in-action within high-fidelity simulation nursing education. This concept analysis also establishes a foundation for reflection-in-action strategy development, as well as suggestions for future research in high-fidelity simulation nursing education.