The Reflection–Performance Gap in Nursing Education: Examining the Role of Self-Regulated Learning in the Relationship Between Learner-Centered Debriefing and Clinical Performance
- Publication History
- Published online: March 7, 2026
- DOI
- https://doi.org/10.35877/454RI.eduline4974
- Copyright
- Copyright (c) 2026 Donna Belle Sumugat & Laelanie Madronero
- User License
- https://creativecommons.org/licenses/by-nc-sa/4.0
Abstract
Learner-centered debriefing and self-regulated learning are widely recognized as important contributors to nursing education, yet their combined influence on clinical performance remains unclear. This mixed-methods study examined the role of self-regulated learning in the relationship between learner-centered debriefing and clinical performance among nursing students in Mindanao, Philippines. Using an explanatory sequential design, quantitative data were collected from 197 Level 3 nursing students through validated questionnaires on learner-centered debriefing and self-regulated learning, while clinical performance ratings were obtained from clinical instructors. Qualitative data were subsequently collected through interviews with students and clinical instructors to explain the quantitative findings. Quantitative analyses revealed very high levels of learner-centered debriefing, self-regulated learning, and clinical performance. Learner-centered debriefing and self-regulated learning were positively associated with clinical performance, and learner-centered debriefing demonstrated a strong positive relationship with self-regulated learning. However, self-regulated learning did not significantly mediate the relationship between learner-centered debriefing and clinical performance. The study identified a reflection–performance gap in nursing education: learner-centered debriefing promoted self-regulated learning, but reflective learning did not automatically translate into improved clinical performance. Qualitative findings revealed that clinical unfamiliarity, fear of mistakes, and competing patient-care demands frequently constrained students’ ability to transform reflection into effective clinical action. Self-regulation remained largely instructor-guided, with students relying on instructor feedback for goal setting, self-monitoring, and help-seeking. Overall, the findings suggest that clinical performance is influenced not only by reflective learning processes but also by technical preparedness, psychological safety, and the realities of the clinical environment.
Keywords
References (32)
- Arianpoor, A., Dabbagh, N., Khoshgoftar, M., & Hajian-Tilaki, K. (2024). Teaching strategies for enhancing self-regulated learning and clinical performance among nursing students: A mixed-method study. BMC Medical Education, 24(47), 1–12.
- Berragan, L. (2023). Mirroring the master: The social cognitive process of post-conference coaching. Nursing Standard, 38(5), 14–22.
- Braun, V., & Clarke, V. (2013). Successful qualitative research: A practical guide for beginners. SAGE.
- Brown, T., & Williams, B. (2024). The "Invisible Wall": Environmental noise and interpersonal stress as moderators of clinical judgment. Advances in Medical Education and Practice, 15, 89–101.
- Cheng, A., Grant, V., & Eppich, W. (2023). Psychological safety in healthcare debriefing: A cultural analysis of power distance. Simulation in Healthcare, 18(1), 45–52.
- Choi, J., & Kim, Y. J. (2024). The cognitive-physical disconnect: Why high-fidelity simulation reflection fails to translate to bedside action. International Journal of Nursing Education Scholarship, 21(1), 20230045.
- Commission on Higher Education. (2017). CHED Memorandum Order No. 15, series of 2017: Policies, standards, and guidelines for the Bachelor of Science in Nursing (BSN) program.
- Dizon, J. M. (2023). Bridging the theory-practice gap in Philippine nursing education: A policy review. Philippine Journal of Nursing, 93(1), 12–25.
- Dizon, J. M., & Reyes, M. A. (2022). Clinical readiness and patient safety practices among nursing students in selected Philippine nursing schools. Philippine Journal of Nursing, 92(2), 45–56.
- Duff, J., Morse, K. J., Seelandt, J., Gross, I. T., Lydston, M., Sargeant, J., Dieckmann, P., Allen, J. A., Rudolph, J. W., & Kolbe, M. (2024). Debriefing methods for simulation in healthcare: A systematic review. Simulation in Healthcare, 19(1S), S112–S121.
- Flores, R. L., Santos, J. P., & dela Cruz, A. L. (2023). Professional behavior and safety compliance of nursing students during clinical exposure. Nurse Media Journal of Nursing, 13(1), 67–78.
- Foster, G. J. (2023). Unidimensionality in health education constructs: A statistical artifact or cultural reality? Journal of Applied Statistics in Education, 29(2), 44–58.
- Goh, Y. S., Selvam, S. P., & Shorey, S. (2022). Factors influencing nursing students’ clinical judgment in the hospital setting: A systematic review. Nurse Education Today, 111, 105315.
- Gupta, N., Ali, K., Jiang, D., Fink, T., & Du, X. (2024). Beyond autonomy: Unpacking self-regulated and self-directed learning through the lens of learner agency—A scoping review. BMC Medical Education, 24, 1519.
- INACSL Standards Committee. (2021). Healthcare simulation standards of best practice™: The debriefing process. Clinical Simulation in Nursing, 58, 27–32.
- INACSL Standards Committee. (2023). Healthcare simulation standards of best practice™: Debriefing. Clinical Simulation in Nursing, 69, 1–10.
- Jenkins, K. (2024). Transition shock: The first 48 hours of senior clinical rotations. Nursing Education Perspectives, 45(2), 210–215.
- Kalengamaliro, J., & Mwale, O. (2023). The hierarchy of silence: Why nursing students hide performance gaps during debriefing. Frontiers in Psychology, 14, 110243.
- Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Prentice Hall.
- Labrague, L. J. (2022). Psychological resilience, clinical stress, and clinical performance among Philippine nursing students. Journal of Nursing Scholarship, 54(2), 150–158.
- Li, Y., & Zhang, X. (2023). Performance anxiety and its impact on the clinical reasoning of senior nursing students. Journal of Advanced Nursing, 79(4), 1422–1434.
- Miller, A. M. (2023). Beyond the rubric: Administrative complexity and clinical readiness in undergraduate nursing. Journal of Nursing Management, 31(3), 560–571.
- Pintrich, P. R. (2004). A conceptual framework for assessing motivation and self-regulated learning in college students. Educational Psychology Review, 16(4), 385–407.
- Pintrich, P. R., Smith, D. A. F., Garcia, T., & McKeachie, W. J. (1991). A manual for the use of the Motivated Strategies for Learning Questionnaire (MSLQ). University of Michigan.
- Professional Regulation Commission. (2003). Implementing rules and regulations of the Philippine Nursing Act of 2002 (Republic Act No. 9173).
- Reed, S. J. (2012). Debriefing experience scale: Development of a tool to evaluate the student learning experience in debriefing. Clinical Simulation in Nursing, 8(6), e211–e217.
- Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204–211.
- Tinajero, C., Mayo, M. E., Villar, E., & Martínez-López, Z. (2024). Classic and modern models of self-regulated learning: Integrative and componential analysis. Frontiers in Psychology, 15, 1307574.
- Villanueva, C. A., & Cruz, J. P. (2024). Variability in clinical competence and professional comportment among senior nursing students in the Philippines. Belitung Nursing Journal, 10(1), 23–31.
- World Health Organization. (2021). Global patient safety action plan 2021–2030: Towards eliminating avoidable harm in health care.
- Yang, L., & Cheng, X. (2022). The "Notebook" effect: Externalized metacognition and its impact on clinical independence. Learning and Instruction, 80, 101602.
- Zimmerman, B. J. (2002). Becoming a self-regulated learner: An overview. Theory Into Practice, 41(2), 64–70.
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