Nursing faculty travel to Taiwan for debriefing research partnership

Drs. Kristina Thomas Dreifuerst, Aimee Woda represent Marquette halfway around world

Debriefing after clinical nursing simulations is nothing new for the College of Nursing’s Dr. Kristina Thomas Dreifuerst and Dr. Aimee Woda — both have guided students through the process of reacting to, analyzing and reflecting on simulated patient care many times. 
Doing it through a translator in Taiwan, however, was a first. 
“There’s definitely a language barrier,” says Woda, associate professor of nursing. “Our contacts at the university spoke great English, but the faculty and students did not speak much, so we had to do everything through interpreters.” 
That was just one of the challenges the two faced when they traveled to Taiwan in October on a grant from the island’s Ministry of Science and Technology. Dreifuerst, professor of nursing and director of the college’s Ph.D. program, has a novel debriefing method that the pair were able to bring to some of Taiwan’s top nursing educators.  
Through multiple in-depth sessions, Woda and Dreifuerst created the cultural understanding necessary to teach a program from Milwaukee on the other side of the world to improve nursing education and ultimately patient outcomes. 

What is this debriefing method and why is it significant? 
DREIFUERST: This is a method that I created in 2008. It’s called DML or Debriefing for Meaningful Learning. It’s used to develop clinical reasoning skills in students and to help with readiness for practice. It’s been adopted by over 500 higher education institutions nationally in the U.S. and by other countries as well, but never in Taiwan. This grant was meant to bring it to Taiwan by replicating the research first done in the U.S. 
Why did the Taiwanese government deem DML worthy of funding? 
WODA: The reason it was funded is to infuse a different kind of thinking in Taiwanese nurses. Their nursing profession is moving in the same direction as in the U.S. where it’s more of a collaborative, team effort and not just doing work that’s ordered by a provider. This debriefing method helps students learn to think along more autonomous, team-focused lines and to improve clinical decision making accordingly. That’s a change from how they were being taught previously. 

Who was in your training session and what approach did you use to train them? 

DREIFUERST: We used Aimee’s “train the trainer” model over the past few years, which is what we used in the U.S. as well. We trained a couple of nursing faculty and then checked them by watching video recordings of their debriefing to assess how effectively it was done. Then they would teach the debriefing method to other faculty and they and we would check the video recordings again, to first see how well the debriefing was done and also how well their trainers assessed them, so we had agreement. We also assessed student learning outcomes following DML and compared them to outcomes from nursing students in the U.S. 
What was the most significant cultural difference you encountered aside from the language barrier? 
WODA: This method of debriefing is Socratic and relies on open-ended questioning and reflection, which is not typical in Taiwanese culture. Their students were used to wanting to provide the objectively correct answer, so this was a change in the way they usually did debriefing and took some time for students and faculty to get used to. 
On the flip side, is there anything about this experience that made it easier compared to the other training sessions you’ve run? 
DREIFUERST: We have been so intimately involved with this group in a long process over many years, so we were able to train and re-train as necessary and really work with the culture differences to ensure adoption of the method in a robust way. With other places, either I or other members of the team would do training for a couple of days and that would be it. This group wanted to replicate the research while they were also implementing the method and that long time commitment and relationship was unique. 
We’ve been able to maximize our relationship as an international research team on Zoom, but there were still a lot of issues in the beginning with the language barrier and time zone differences. Being there in person this fall helps contextualize some of the things they’re saying to us and better understand the research data they have collected.  

WODA: Most of the time when I’m doing training here in the U.S., it’s a lot of remote interaction and communication and you don’t really get that real-time, in-person feedback component. Oftentimes, I’m watching a video recording and sending them feedback via email. It was nice to be able to see things in person and give that instruction on the spot. 

Did you have any time to sightsee or were you working all the way through? 
WODA: It was almost all working, but they treated us very well. We had a day where we went to their National Palace Museum and the Taipei 101, which is the tallest building in Taiwan. They also fed us a lot of special Taiwanese food like Peking duck.  

Describe something that’s seen as normal in Taiwan but is different from the way we live in Wisconsin. 

WODA: Everything was urban and so busy; for some reason, I didn’t picture it like that before I went. It reminded me of New York City. 
DREIFUERST: We were able to travel around to different universities on the high speed rail, so we also saw the rural parts of Taiwan. That said, you’re aware that you’re on an island. They have earthquakes almost every week, which is foreign to us in Milwaukee!  

What does the future hold for this collaboration? 

DREIFUERST: We are applying for a continuation grant from the Taiwan Ministry of Science and Technology, which would support this research through 2027. Our Taiwanese research colleagues are also already talking about having members of our research team come back as early as next summer. They also have some interest in sending some faculty to Marquette, so they’re really thinking about this as a continuing relationship. 
Just this morning, we had a team meeting with them and they’re starting to think about their student’s readiness for entry to practice, which is something we’ve been working on too. I think there’s going to be lots of opportunities for collaboration going forward.