Effects of high-fidelity simulation on the critical thinking skills of baccalaureate nursing students: A causal-comparative research study

Simulation-Based Learning Supported by Technology to Enhance Critical Thinking in Nursing Students: Scoping Review

BACKGROUND

Critical thinking is a crucial skill in the nursing profession and must be fostered through nursing education. Simulation-based learning (SBL) with technological modalities is a pedagogical approach to enhance critical thinking skills for nursing students. The use of technology in SBL to achieve critical thinking skills is diverse. No previous scoping review has systematically mapped studies on SBL supported by technology to enhance critical thinking in nursing students.

OBJECTIVE

This scoping review aimed to systematically map research on the use of SBL supported by technology to enhance critical thinking in nursing students.

METHODS

This scoping review was conducted according to the framework by Arksey and O'Malley and was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A systematic, comprehensive literature search was performed in the LILACS, ERIC, MEDLINE, Embase, PsycINFO, and Web of Science databases in 2021 and repeated in 2023 and 2024. Pairs of authors independently assessed titles, abstracts, and full-text papers and extracted data from the included studies. The data underwent summative and thematic analysis and were categorized according to the findings.

RESULTS

In total, 4 main categories of technology applied in SBL were identified: computer-based simulations, human-patient simulators, virtual reality or immersive virtual reality, and others. The findings revealed a shift across time in the technology used for SBL to enhance critical thinking, from human patient simulators to computer-based simulations. A dominant part of the included studies published after 2018 (21/44, 48%) incorporated a combination of asynchronous and synchronous learning activities. The theoretical foundation of the studies revealed a range of scientific theories and conceptual frameworks and models. Enablers of or barriers to the enhancement of critical thinking skills in nursing students were identified within the following themes: affinity for and availability of technology, realism, accessibility, engagement and motivation, validation, return on investment, and enhanced critical thinking through SBL using technology.

CONCLUSIONS

There has been a noticeable shift in the technology and use of technology in SBL. Descriptions of the applied technology and pedagogical considerations are pivotal for comparing or synthesizing research results. There has been a trend toward a blended educational approach combining synchronous and asynchronous learning activities. User technological proficiency and the perceived quality of the technology are imperative in the development of critical thinking. Realism, engagement, and motivation play pivotal roles in the enhancement of critical thinking in technologically supported SBL. The establishment of robust theoretical foundations of research and standardized research practices will strengthen the evidence obtained from the research conducted.

Refining clinical judgment competence in nursing education in the Philippines: A mixed-methods study on the impact of the Philips 66 brainstorming technique in case-based learning

Background

Clinical judgment is crucial for nurses in complex healthcare settings. In the Philippines, nursing students must develop critical thinking and decision-making skills to handle resource-limited environments and challenging patient care. However, existing educational methods often fail to engage students and fully promote diverse perspectives.

Objective

This study aimed to examine the effect of integrating the Philips 66 technique into Case-Based Learning (CBL) on enhancing clinical judgment competence among Filipino nursing students.

Methods

This study utilized an explanatory sequential mixed methods design. The quantitative phase involved a true experimental pre-test/post-test design with 60 senior nursing students randomly assigned to intervention (n = 30) and control (n = 30) groups. The intervention group participated in the Philips 66 technique with CBL, while the control group followed standard CBL. Clinical judgment competence was assessed using the Lasater Clinical Judgment Rubric (LCJR) and a researcher-designed/validated questionnaire to measure confidence. Focus group discussions (FGDs) with a subset of the intervention group explored their experiences with the Philips 66 technique. Data were analyzed using descriptive statistics and non-parametric tests for the quantitative component, while thematic analysis was applied to qualitative data.

Results

The intervention group significantly outperformed the control group in both self-reported confidence and overall clinical judgment abilities. The Philips 66-CBL group showed significant improvements (p <0.005, r (effect size) = 0.66 - 0.71) in all areas, while the control group demonstrated significant improvements in information seeking, evaluation/self-analysis, and commitment to improvement (p <0.001, Cohen's d = 0.54 - 0.617). Qualitative data from FGDs highlighted the value of Philips 66 in fostering teamwork, rapid knowledge sharing, and increased efficiency in addressing clinical scenarios, which are essential skills for nursing practice.

Conclusion

The combination of the Philips 66 technique with CBL significantly improves the clinical judgment abilities of Filipino nursing students in a shorter timeframe compared to conventional approaches. Insights from qualitative data highlight its effectiveness in fostering collaborative learning and preparing students for the challenges of dynamic clinical settings. Further research with larger, more diverse samples across different contexts is essential to confirm these findings and explore the long-term influence of Philips 66-CBL on nursing students' clinical judgment development worldwide.

Trial Registry Number

NCT06646068 [clinicaltrias.gov].

Philippine Health Research Registry

PHRR241010-007605 [registry.healthresearch.ph].

The relationship between virtual simulation, critical thinking, and self-directed learning abilities of nursing students in Riyadh, Saudi Arabia

Objective

The use of virtual simulation in nursing education is an effective approach for improving nursing critical thinking and self-learning abilities, but the previous studies were limited to providing the required evidence that supports the association. This study aimed to assess the relationship between virtual simulation and critical thinking disposition and self-directed learning abilities among nursing students.

Methods

This is a descriptive correlational, non-experimental study. It was conducted among 201 third- and fourth-year nursing students at the Academic Institution, Saudi Arabia. A non-probability convenience sampling technique was used to select the participants; then, an online, adapted questionnaire was sent to the participants, the data from which was analyzed by SPSS.

Results

The study findings showed that virtual simulation benefited nursing students. Most participants (56%) agreed that it helped them to think critically, and approximately 27% strongly agreed. It also enhanced their self-directed learning abilities, and the majority of the students agreed that they often review the way nursing practice is conducted. Furthermore, the results showed a significant, positive relationship between virtual simulation and the critical thinking disposition of nursing students (p-value = 0.03; correlation coefficient = 0.65), a strong positive relationship with self-directed learning abilities of nursing students (p-value = 0.004; correlation coefficient = 0.78), and a strong positive relationship between critical thinking disposition with self-directed learning abilities of nursing students (p-value = 0.01; correlation coefficient = 0.72).

Conclusion

There are significant relationships between virtual simulation and the critical thinking disposition and self-directed learning abilities of nursing students. Furthermore, virtual simulation made the students practice critical thinking and self-learning, so, they simulate events and try to seek out and solve the problems.

The impact of applying unfolding case-study learning on critical care nursing students' knowledge, critical thinking, and self-efficacy; a quasi-experimental study

BACKGROUND

The unfolding case-study learning approach is a growing modernized learning strategy implemented in different health disciplines. However, there is a lack of existing research that examines the effects of unfolding case studies in advanced nursing courses.

AIM

To examine the impact of applying an unfolding case-study learning approach on critical care nursing students' knowledge, critical thinking, and self-efficacy.

METHODS

This posttest-only, quasi-experimental study was conducted at XXX University in Palestine. A single-stage cluster sampling was used to assign nursing students enrolled in the critical care nursing course into experiment and conventional groups. The intervention group (n= 91) underwent unfolding case-study learning for selected cardiovascular topics, whereas the conventional group (n= 78) was taught using the traditional teaching methods. The posttest assessment was conducted using Knowledge Acquisition tests, Yoon`s Critical Thinking Disposition Instrument (YCTD), and the Self-Efficacy for Learning and Performance instruments. The Social Constructivist Theoretical Framework was integrated into the study.

RESULTS

Homogeneity was achieved between both groups concerning Age, Gender, and GPA. The experiment group scored significantly higher than the conventional group regarding the posttest knowledge acquisition tests (7.12 vs. 5.49, respectively, t=-12.7, P<0.001, CI: -1.89 to -1.38), critical thinking (4.32 vs. 3.63 respectively, t=17.390, p<0.001, CI: -77 to -61) and self-efficacy (6.12 vs. 4.4 respectively, t=-30.897, p<0.001, CI: -1.82 to -1.60). Multivariate analysis revealed that 69 % of the variations of posttest scores were influenced by critical thinking scores (Adjusted R Squared=0.690, F=3.47, P=0002, η2=0.969). Similarly, self-efficacy has been shown to contribute by 74 % to the variations of scores after conducting the study program (Adjusted R Squared=0.743, F=4.21, P=0001, η2=0.974). However, the variations of both critical thinking and self-efficacy scores were not significantly influenced by the contribution of knowledge acquisition (p=0.772 and 0.857, respectively) and students' GPA (p=0.305 and 0.956, respectively).

CONCLUSIONS

Irrespective of knowledge level and GPA, the unfolding case-study learning approach can enhance the critical thinking and self-efficacy of students enrolling in advanced nursing courses.

Current practices for assessing clinical judgment in nursing students and new graduates: A scoping review

OBJECTIVE

To map current assessment practices for learning outcomes related to nurses' clinical judgment from undergraduate education to entry to practice.

DESIGN

Scoping review using the Joanna Briggs Institute guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

DATA SOURCES

Electronic databases-Cumulative Index of Nursing and Allied Health Literature (CINAHL Complete; EBSCOhost), EMBASE (Ovid), MEDLINE (Ovid), PsycINFO (Ovid), and Web of Science (Social Sciences Citation Index, Citation Index Expanded)-using a combination of descriptors and keywords related to nursing students, newly graduated nurses, clinical judgment and related terms (e.g., critical thinking, clinical reasoning, clinical decision-making, and problem-solving), and assessment.

METHODS

Two reviewers independently extracted study characteristics and, for each outcome relevant to clinical judgment, the concept, definition and framework, assessment tool, and the number and schedule of assessments. Data were synthesized narratively and using descriptive statistics.

RESULTS

Most of the 52 reviewed studies examined the outcome of a discrete educational intervention (76.9 %) in academic settings (78.8 %). Only six studies (11.5 %) involved newly graduated nurses. Clinical judgment (34.6 %), critical thinking (26.9 %), and clinical reasoning (9.6 %) were the three most frequent concepts. Three assessment tools were used in more than one study: the Lasater Clinical Judgment Rubric (n = 22, 42.3 %), the California Critical Thinking Skills Test (n = 9, 17.3 %), and the Health Science Reasoning Test (n = 2, 3.8 %). Eleven studies (21.2 %) used assessment tools designed for the study.

CONCLUSION

In addition to a disparate understanding of underlying concepts, there are minimal published studies on the assessment of nursing students and nurses' clinical judgment, especially for longitudinal assessment from education to clinical practice. Although there is some existing research on this topic, further studies are necessary to establish valid and reliable clinical competency assessment methods that effectively integrate clinical judgment in clinical situations at relevant time points.

Exploring mobile mixed reality for critical thinking in nursing and healthcare education: A systematic review

BACKGROUND

The shortage of nursing and healthcare clinical placements has prompted the investigation of ways to supplement authentic learning. Mobile mixed reality has become increasingly available, however, the affordances and design principles for the facilitation of critical thinking are yet to be explored.

OBJECTIVE

To examine how mobile mixed reality facilitates critical thinking in nursing and healthcare higher education.

DESIGN

Systematic review.

REVIEW METHODS

A search in seven databases (MEDLINE, PsychINFO, AMED, ERIC, Scopus, Cochrane, and Web of Science) was conducted with 3488 titles and abstracts screened. The quality of the included studies was evaluated using the Mixed Methods Assessment Tool (MMAT).

RESULTS

A total of 12 studies with 1108 participants were included. The breadth of healthcare disciplines was limited to five disciplines that utilised bespoke scenarios on head-mounted displays. Most scenarios were emergency or critical response, with limited time for pre-brief, debrief, or overall user time. Only two studies directly measured critical thinking, with others including indirect reference to diagnoses, interpretation, analysis, or evaluation of healthcare scenarios. Affordances and design principles for the future development of mobile mixed reality for critical thinking in nursing and healthcare higher education are identified.

CONCLUSIONS

While some pedagogical affordances of mobile mixed reality can be identified in a narrow number of healthcare disciplines, there remain to be limited valid measures of critical thinking used to quantify effectiveness. Future studies would benefit from considering scenarios beyond emergency and critical responses, including longitudinal studies that reflect the development of critical thinking over time, and exploration of co-designed scenarios with and by nursing and healthcare students.

The effectiveness of high-fidelity simulation on undergraduate nursing students' clinical reasoning-related skills: A systematic review

BACKGROUND

High-fidelity simulation is used widely in the education of healthcare professionals; however, its effectiveness in teaching undergraduate nursing students clinical reasoning skills is not known. The objective of this systematic review is to synthesise findings from current literature about the effectiveness of high-fidelity simulation on the development of clinical reasoning-related skills in undergraduate nurses.

METHODS

A systematic review of the effectiveness of high-fidelity simulation was conducted, guided by the Joanna Briggs Institute methodology. Studies included were experimental and quasi-experimental study designs published in English between 2014 and 2020 that investigated clinical reasoning-related skills for undergraduate nursing students. Databases searched included Medline, CINAHL, Embase and the Joanna Briggs Institute of Evidence-based Practice database.

RESULT

A total of 1980 studies were identified and 15 studies met the inclusion criteria. Seven studies were randomised controlled trials, and eight studies were quasi-experimental. The 15 included studies reported 19 outcomes, as studies examined one or more outcomes of clinical reasoning-related skills. Statistically significant results favouring the simulation groups were reported in the following outcomes: clinical reasoning skills (three studies of three studies), critical thinking skills (four out of eight studies), problem-solving (two of four studies), decision-making skills (one of two studies), and clinical judgment skills (two of two studies).

CONCLUSION

High-fidelity simulation was reported to be effective alone and in combination with traditional teaching or other simulation types in improving undergraduate nursing students' clinical reasoning-related skills acquisition. Limitations included cost and availability of high-fidelity simulation to large numbers of students, which have implications for practice. Further research is needed to determine the actual effect of high-fidelity simulation compared to other simulation types on undergraduate nursing students' clinical reasoning-related skills.

Effects of Blended Simulation on Nursing Students' Critical Thinking Skills: A Quantitative Study

Introduction

Critical thinking is regarded as imperative to healthcare quality and patient outcomes; therefore, effective strategies in nursing education are required to promote students' critical thinking abilities, leading to their success in clinical work. Accordingly, simulation-based education has been suggested as a measure for achieving this goal.

Objective

The aim of this study was to explore whether a nursing education course with blended simulation activities (hands-on simulations with high-fidelity manikins and a web-based interactive simulation program) could increase nursing students' critical thinking skills.

Method

A quasiexperimental, one-group pretest and post-test design was utilized. Data were collected through premeasurement and postmeasurement using a critical thinking questionnaire and were analyzed using paired sample t-tests, independent sample t-tests, and the nonparametric Wilcoxon signed-rank test. The effect size was calculated using Cohen's d formula.

Results

Sixty-one nursing students (57 women and four men, mean age 30 years) participated in the study. Findings of the paired sample t-test showed a significantly higher mean score for posteducation than pre-education, indicating a significant change in nurses' critical thinking capabilities (p < .001). The results for Cohen's d formula ( - 0.87) of the mean scores between pre-education and posteducation indicated a large effect size. The Wilcoxon signed-rank test also showed a statistically significant increase in the students' critical thinking abilities between pre-education and posteducation measures (p < .001). No statistically significant differences were found in the mean score according to age or sex.

Conclusion

This study concluded that blended simulation-based education can increase nursing students' critical thinking capabilities. As a result, this study builds on the use of simulation as a measure for developing and promoting critical thinking abilities during nursing education.

Brazilian undergraduate nursing students’ critical thinking need to be increased: a cross-sectional study

ABSTRACT Objectives: to map Brazilian undergraduate nursing students’ critical thinking level and investigate the correlation between selected sociodemographic data and critical thinking domains. Methods: in this descriptive cross-sectional study, participants’ (N=89) critical thinking was assessed using the Health Science Reasoning Test. Correlation between critical thinking domains and sociodemographic data was assessed using the Pearson correlation coefficient. Results: the overall results showed a moderate level of participants’ critical thinking (mean = 70.7; standard deviation 5.7). A poor performance was identified in 5 of the 8 critical thinking domains. A significant positive correlation was found between education period and critical thinking (p<.001). Conclusions: poor level in students critical thinking domains may lead to negative consequences for their learning outcomes. Further studies should be carried out to confirm our results, in addition to investigation of teaching methods that encourage and ensure the development of students’ critical thinking skills during nursing education.

Effect of Manikin and Virtual Simulation on Clinical Judgment

BACKGROUND

Evidence suggests competency in clinical judgment may be lacking in new graduate nurses. Graduates from accelerated baccalaureate nursing (ABSN) programs have even less time to develop clinical judgment competency. Various simulation modalities, including high-fidelity manikin and virtual reality, have been used to develop clinical judgment in prelicensure students. However, the outcomes of these simulation modalities on clinical judgment in ABSN students is not well understood.

METHOD

An integrative literature review was conducted using five databases with primary research that examined the effect of manikin or virtual simulation on clinical judgment in BSN students.

RESULTS

Fourteen studies were included in this review. The findings were organized using Tanner's Clinical Judgment Model.

CONCLUSION

Findings from this review were mixed, with a lack of evidence comparing the two modalities. Future research should include comparison studies aimed at examining the effects of these modalities with ABSN students. [J Nurs Educ. 2022;61(12):693-699.].

Promoting critical thinking through simulation-based healthcare training (SBHT): A scoping review

Background. Critical thinking (CT) is an essential graduate attribute for health professions (HP) students. Yet, achieving a higher level of CT in HP students through education is often difficult for educators. SBHT has proven to be an effective strategy to promote CT, but it is not clear how this educational pedagogy should be implemented to achieve higher levels of CT.Objective. To identify and describe the use of simulation-based healthcare training (SBHT) strategies to promote CT in HP students. Methods. Based on the revised methodology of Levac et al., a scoping review was conducted on studies reporting an improvement in CT through simulation-based healthcare education published between January 2010 and August 2021.Results. Twenty articles were included. Through thematic analysis, three main themes were identified: contact simulations, computer-based simulations, and debriefing. The focus was on how these approaches were used to promote CT. Various subthemes were also identified. Conclusion. Correctly planning and implementing a simulation-based experience that relates to the relevant learning activities, combined with repeat practice and guided reflection during the debriefing stage, improves the CT skills of HP students.

Simulation-Based Learning Supported by Technology to Enhance Critical Thinking in Nursing Students: Protocol for a Scoping Review

BACKGROUND

Critical thinking is a crucial skill in the nursing profession, so teaching strategies and methodology must be carefully considered when training and preparing nursing students to think critically. Studies on simulation-based learning supported by technology are increasing in nursing education, but no scoping reviews have mapped the literature on simulation-based learning supported by technology to enhance critical thinking in nursing students.

OBJECTIVE

The proposed scoping review aims to systematically map research on the use of simulation-based learning supported by technology to enhance critical thinking in nursing students.

METHODS

The proposed scoping review will use the framework established by Arksey and O'Malley and will be reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. A systematic, comprehensive literature search was performed in the LILACS, ERIC, MEDLINE, EMBASE, PsycINFO, and Web of Science databases. Pairs of authors independently selected the articles by screening titles, abstracts, full-text papers, and extract data. The data will be analyzed and thematically categorized.

RESULTS

The development of a comprehensive and systematic search strategy was completed in June 2021. The database searches were performed in July 2021, and the screening of titles and abstracts was completed in September 2021. Charting the data began in February 2022. Analysis and synthesis will be performed sequentially, and the scoping review is expected to be complete by May 2023.

CONCLUSIONS

The results of this proposed scoping review may identify gaps in the literature and provide an overview of research on the topic of simulation-based learning supported by technology to enhance critical thinking in nursing students. The research may identify nursing students' reported barriers and enablers for learning critical thinking skills through simulation-based learning supported by technology, and the results may help educators enhance their educational approach through knowledge of students' firsthand experiences and further development of successful teaching strategies in nursing education.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/36725.

High-fidelity simulation in undergraduate nursing education: A meta-analysis

OBJECTIVES

To explore the effectiveness of high-fidelity simulation (HFS) in undergraduate nursing education.

DESIGN

A meta-analysis of randomized controlled trials and quasi-experiment.

DATA SOURCES

Web of Science, PubMed, Embase, Cochrane Library, WANFANG, and CNKI were searched for eligible articles published in English and Chinese until May 28, 2021.

REVIEW METHODS

The Quality Appraisal Check-list for Quantitative Intervention Studies was applied to the quality evaluation. Standard mean differences (SMD) were pooled using a random effects model. The results of the individual and combined intervention effects estimation of was displayed in a forest plot, with weight, SMD, its corresponding 95% confidence interval (CI), Z-test, p, I².

RESULTS

Thirty-eight studies were included and 37 were analyzed. High-fidelity simulation (HFS) revealed significantly larger effect sizes for knowledge (SMD = 0.89, 95% CI [0.54 to 1.23]), skill (SMD = 0.93, 95% CI [0.69 to 1.17]), collaboration (SMD = 0.52, 95% CI [0.26 to 0.78]), caring (SMD = 1.40, 95% CI [0.23 to 2.58]) and learning interest (SMD = 0.85, 95% CI [0.00 to 2.04]) when compared with other teaching methods. However, no significant difference between HFS and other teaching methods in critical thinking (SMD = 0.46, 95% CI [-1.12 to 1.58]), self-confidence (SMD = 0.22, 95% CI [-0.32 to 0.75]) and learning satisfaction (SMD = 0.58, 95% CI [-0.25 to 1.41]) was shown.

CONCLUSIONS

High-fidelity simulation (HFS) can more effectively cultivate knowledge, skills, collaboration, caring, and learning interest of undergraduate nursing students. Since the effect of HFS is equivalent to other teaching methods in cultivating undergraduate nursing students' critical thinking, self-confidence and learning satisfaction, nursing educators can choose the most appropriate methods to achieve the intended learning outcomes according to the actual situation.

Repeated Simulation Experience on Self-Confidence, Critical Thinking, and Competence of Nurses and Nursing Students-An Integrative Review

Background

Simulation is the most adopted teaching methodology in nursing education.

Objectives

This article investigated the outcome of repeated simulation experience on self-confidence, critical thinking, knowledge, competence, and satisfaction of nurses and nursing students.

Methods

The Scholarly literature published in English for the period of 2011 to 2019 was reviewed.

Results

Repeated simulation enhances students' self-confidence, knowledge, competence, critical thinking, and satisfaction.

Conclusions

Repetitive simulation experience is valued by the nurse educators as a valuable teaching methodology to reinforce the student's learning outcomes.