Korean J Adult Nurs.  2013 Oct;25(5):574-584.

Effects of a Simulation based Clinical Reasoning Practice Program on Clinical Competence in Nursing Students

• Hur HK
• Roh YS

Abstract

PURPOSE
The purpose of this study was to evaluate the effects of a simulation based clinical reasoning practice program on clinical competence in nursing students. The program was based on the theoretical frameworks of simulation models and experiential learning theory.
METHODS
The program consisted of eight scenarios which includes three main symptoms (abdominal pain, changes in mental status, dyspnea), for improvement of clinical competencies in nursing students. A nonequivalent control group pretest-posttest design was used for evaluation of the effects of the program. Fifty-two junior nursing students in Y University participated in the experimental group (n=25) or control group (n=27). Critical thinking was measured using a self-administered questionnaire. Clinical judgment and clinical performance were measured by a rater using the Rubric. Descriptive analysis, t-test, Mann-Whitney U, Wilcoxon signed rank test was used for data analyses.
RESULTS
Clinical judgment and clinical performance increased in the experimental group, but there were no significant differences in critical thinking.
CONCLUSION
Results indicate that the program developed in this study is a useful strategy to enhance clinical judgment and clinical performance in nursing students. However, the program did not significantly enhance critical thinking disposition, and further study is needed to measure integrated clinical competence including critical thinking skills.

MeSH Terms

Clinical Competence*
Humans
Judgment
Nursing*
Patient Simulation
Problem-Based Learning
Statistics as Topic
Students, Nursing*
Thinking
Surveys and Questionnaires

Figure

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  Figure 1 Conceptual framework of the study.

Reference

1. Bland AJ, Topping A, Wood BA. Concept analysis of simulation as a learning strategy in the education of undergraduate nursing students. Nurse Educ Today. 2011; 31:664–670. DOI: 10.1016/j.nedt.2010.10.013.

2. Blum CA, Borglund S, Parcells D. High fidelity nursing simulation: Impact on student self-confidence and clinical competence. Int J Nurs Educ Scholarsh. 2010; 7(1):1–14. DOI: 10.2202/1548-923X.2035.

3. Cant RP, Cooper SJ. Simulation-based learning in nurse education: systematic review. J Adv Nurs. 2010; 66:3–15. DOI: 10.1111/j.1365-2468.2009.05240.x.

4. Chang SO, Kong ES, Kim CG, Kim HK, Song MS, Ahn SY, et al. Exploring nursing education modality for facilitating undergraduate students' critical thinking focus goup interview analysis. Korean J Adult Nurs. 2013; 25:125–135. DOI: 10.7475/kjan.2013.25.2.125.

5. Clark M. Evaluating an obstetric trauma scenario. Clin Simul Nurs Educ. 2006; 2:e75–e77. DOI: 10.1016/j.ecns.2009.05.028.

6. Davis AH, Kimble LP. Human patient simulation evaluation rubrics for nursing education: Measuring the essential of baccalaureate education for professional nursing practice. J Nurs Educ. 2011; 50:605–611. DOI: 10.3928/01484834-20110715-01.

7. Hur HK, Park S, Shin YH, Lim YM, Kim GY, Kim KK, et al. Development and applicability evaluation of an emergency care management simulation practicum for nursing students. J Korean Acad Soc Nurs Educ. 2013; 19:111–119. DOI: 10.5977/jkasne.2013.19.2.228.

8. Hur HK, Park SM, Kim KK, Jung JS, Shin YH, Choi HO. Evaluation of Lasater judgment rubric to measure nursing student's performance of emergency management simulation of hypoglycemia. J Korean Crit Care Nurs. 2012; 5:15–27.

9. Jeffries PR. A framework for designing, implementing, and evaluation simulations used as teaching strategies in nursing. Nurs Educ Perspect. 2005; 26:96–103.

10. Kaakinen J, Arwood E. Systematic review of nursing simulation literature for use of learning of theory. Int J Nurs Educ Scholarsh. 2009; 6(1):1–20. DOI: 10.2202/1548-923X.1688.

11. Kang HW, Hur HK. Development of a simulation scenario on emergency nursing care of dyspnea patients. J Korean Crit Care Nurs. 2010; 3:59–74.

12. Kern DE, Thomas PA, Hughes MT. Curriculum development for medical education. 2nd ed. Baltimore: Johns Hopkins University Press;2009.

13. Ko JK, Chung MS, Choe MA, Park YI, Bang KS, Kim JA, et al. Modeling of nursing competencies for competency-based curriculum development. J Korean Acad Soc Nurs Educ. 2013; 19:87–96. DOI: 10.5977/jkasne.2013.19.1.87.

14. Kolb D. Experiential learning: Experience as the source of learning and development. New Jersey: Prentice Hall;1984.

15. Larew C, Lessans S, Spunt D, Foster D, Covington BG. Innovations in clinical simulation: Application of Benner theory in an interactive patient care simulation. Nurs Educ Perspect. 2006; 27:16–22.

16. Lasater K. Clinical judgment development: Using simulation to create an assessment rubric. J Nurs Educ. 2007; 46:496–503.

17. Lee JH, Choi M. Evaluation of effects of a clinical reasoning course among undergraduate nursing students. Korean J Adult Nurs. 2011; 23:1–9.

18. Lee KW, Ko JY, Choi PY, Jung MK, Park SH. Educational psychology for effective teaching learning strategy. 2nd ed. Seoul: Kyoyookbook Co;2011.

19. Lee SH. Curriculum development: Theory into practice. Seoul: Hakjisa;2008.

20. Lenburg CB. The framework, concepts, and methods of the competency outcomes and performance assessment (COPA) model. Online J Issues Nurs. 1999; 4(2):1–12. Retrieved May 15, 2012. from http://www.nursingworld.org/ojin.

21. Lim KC. Directions of simulation-based learning in nursing practice education: A systematic review. J Korean Acad Soc Nurs Educ. 2011; 17:246–256.

22. Mariani B, Cantrell MA, Meakim C, Prieto P, Dreifuerst KT. Structured debriefing and students' clinical judgment abilities in simulation. Clin Simul Nurs. 2013; 9:e147–e155. DOI: 10.1016/j.ecns.2011.11.009.

23. McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Medical education featuring mastery learning with deliberate practice can lead to better health for individuals and populations. Acad Med. 2011; 86:e8–e9.

24. Oermann MH. Critical thinking, critical practice. Nurs Manage. 1999; 30(4):40C–40F. 40H–40I.

25. Suh EE. Development of a conceptual framework for nursing simulation education utilizing human patient simulators and standardized patients. J Korean Acad Soc Nurs Educ. 2012; 18:206–219. DOI: 10.5977/jkasne.2012.18.2.206.

26. Suh YO, Ahn YH, Park KS. Content validity of experience of nursing students in clinical judgment during nursing practicum. J Korean Acad Adult Nurs. 2009; 21:245–256.

27. Tanner CA. Thinking like a nurse: A research-based model of clinical judgment in nursing. J Nurs Educ. 2006; 45:204–211.

28. Yang JJ. Development and evaluation of a simulation-based education course for nursing students. J Korean Acad Adult Nurs. 2008; 20:548–560.

29. Yoon J. Development of an instrument for the measurement of critical thinking disposition in nursing. Seoul: Catholic University of Korea;2004. Unpublished doctoral dissertation.