Study: Nursing Students Can Increase Clinical Judgment Through Simulation

As a prelicensure nursing professor, I noticed students developed a sharper sense of decision-making skills after repetitive simulation exposure. 

Healthcare Simulation

Simulations in healthcare can involve using a simulator, which is a computerized manikin that can initiate or respond to vocal or human-like responses within its environment. The manikin is controlled by a simulation technician or nursing faculty- typically behind the scenes- without students knowing what the simulator will do next. 

Another option for patient simulation is using live actors to perform according to a scripted scenario. They respond to students in ways that cue them to react, make decisions, and challenge critical thinking.

Background

According to industry research, newly graduated nurses lag in exercising the use of clinical judgment that is necessary to provide prompt, safe, and effective patient care. 

The Study 

I performed a study using a mixed method convergent parallel quasi-experimental and case study approach. My study compared 128 pre-licensure students, divided equally between beginner and advanced levels, as groups participated in high-fidelity simulation (HFS) and multi-patient simulation (MPS) experiences. 

The HFS included a simple Crohn’s disease case scenario for the beginner group. In contrast, the advanced group participated in a more complex situation to have the MPS of a busy emergency department and HFS code blue cardiac arrest scenario. 

Using a tool called the Lasater Clinical Judgment Rubric (LCJR), which is based on Tanner’s Model of Clinical Judgment, I compared these two groups of students using quantitative and qualitative analysis. 

Results

I observed the two groups of students (beginner and advanced). The groups showed marked differences in their abilities to respond to various levels of simulation scenarios.

Qualitative themes that emerged included confidence, prioritizing, fear, communication, problem-solving, and patient safety. 

These themes were cross-checked using triangulation and peer review. Most resoundingly, both groups expressed the desire to improve and identified how to improve. However, the beginner group needed more prompting from the simulation facilitator post-simulation during the debriefing period.

Both groups were able to grasp the need and urgency to develop clinical judgment.  

My study validated other studies conducted showing statistical results supporting the use of simulation in the prelicensure nursing program to help increase students’ clinical judgment skills prior to graduation. 

These subsets were analyzed for qualitative differences, illuminating the breadth and depth of how clinical judgment manifests itself. The LCJR has been studied for years and is a reliable and valid measuring instrument. 

The Need for Experienced Nurses

Older, more experienced nurses are retiring faster than they can be replaced. Compounding this is the significant efflux of seasoned nurses post-COVID-19 pandemic, leaving most acute care facilities staffed primarily of travel nurses and new graduate nurses. Adding to the deficit, many newly graduated nurses are burning out and leaving the profession within their first year of practice. 

Conclusion

Along with focusing on clinical judgment itself, studies have shown simulation can better prepare nursing students with experience for the real world of nursing compared to basic testing procedures. 

This study qualifies with many quantitative studies using qualitative results, helping administrators further appreciate how simulation can help a nursing student learn to “think like a nurse.”