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Original Article

Effects of Simulation on Nursing Students' Knowledge, Clinical Reasoning, and Self-confidence: A Quasi-experimental Study

Ji Young Kim1, Eun Jung Kim2
Korean Journal of Adult Nursing 2015;27(5):604-611.
Published online: October 31, 2015

1College of Nursing, Research Institute of Nursing Science, Chonbuk National University, Jeonju

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Corresponding author: Kim, Eun Jung Division of Nursing, Research Institute of Nursing Science, Hallym University, 1 Hallymdaehak-gil, Chuncheon 200-702, Korea. Tel: +82-33-248-2725, Fax: +82-33-248-2734, E-mail: ejerkim@hallym.ac.kr
• Received: July 16, 2015   • Accepted: October 2, 2015

Copyright © 2015 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    Knowledge, clinical reasoning, and self-confidence are the basis for undergraduate education, and determine students’ level of competence. The purpose of this study was to assess the effects of the addition of a one-time simulation experience to the didactic curriculum on nursing students’ knowledge acquisition, clinical reasoning skill, and self-confidence.
  • Methods
    Using a quasi-experimental crossover design consisted of intervention and wait-list control groups. Participants were non-randomly assigned to the first intervention group (Group A, n=48) or the wait-list control group (Group B, n=46). Knowledge level was assessed through a multiple choice written test, and clinical reasoning skill was measured using a nursing process model-based rubric. Self-confidence was measured using a self-reported questionnaire.
  • Results
    Results indicated that students in the simulation group scored significantly higher on clinical reasoning skill and related knowledge than those in the didactic lecture group; no difference was found for self-confidence.
  • Conclusion
    Findings suggest that undergraduate nursing education requires a simulation-based curriculum for clinical reasoning development and knowledge acquisition.
  • Key Words: Decision making; Knowledge; Undergraduate education; Patient simulation
Figure 1.
Flowchart of the study.
kjan-27-604f1.jpg
Table 1.
Rubric for Evaluating the Clinical Reasoning Skill
Categories   Score and description  
Collecting data 3 Appropriately collects the subjective and objective data related to the patient' s condition 2 Collects the most obvious data, missing some important information 1 Confuses the patient's condition and disorganizes the data
Diagnosing 2 Analyzes and synthesizes the data; describes the diagnosis relevant to data 1 Analyzes and synthesizes the data; describes the diagnosis but less relevant to data 0 Has difficulty analyzing and synthesizing the data; describes the diagnosis but not relevant to data
Prioritizing problem 2 Focuses on the most relevant and important data to patient's condition 1 Focuses on data relevant to patient's condition but less important or not priority 0 Has difficulty with prioritizing; data not relevant to patient's condition
Planning 3 Selects nursing interventions to resolve the problem; appropriately planned interventions based on relevant patient data 2 Selects nursing interventions to resolve the problem; less appropriately planned interventions based on most obvious data 1 Selects a single intervention, addressing a likely solution, but it may be vague, confusing, and/or incomplete
Table 2.
Homogeneity of the Participants' Characteristics between the Groups (N=94)
Characteristics Categories Group A (n=48) Group B (n=46) x2 or t p
n (%) or M±SD n (%) or M±SD
Gender Male 6 (12.5) 5 (10.9) 0.06 .806
Female 42 (87.5) 41 (89.1)  
Age (year)   21.06±1.80 20.98±1.35 0.26 .799
Satisfaction for nursing major   3.60±0.71 3.50±0.86 0.64 .523
Grade point average (GPA)   3.59±0.46 3.53±0.43 0.64 .523
Self-confidence for GI bleed   33.09±5.44 32.60±5.75 0.46 .679
Self-confidence for CS   33.90±5.60 33.33±7.54 0.41 .682

GI bleed=gastrointestinal bleed; CS=compartment syndrome.

Table 3.
Comparison of Knowledge, Clinical Reasoning, and Self-confidence between the Groups (N=94)
Variables Categories Group (n) M±SD t p
Knowledge for GI bleed Simulation/lecture A (48) 6.83±1.93 2.55 .012
Lecture only B (46) 5.70±2.38
Clinical reasoning for GI bleed Simulation/lecture A (48) 6.34±1.88 2.83 .006
Lecture only B (46) 5.22±1.94
Self-confidence for GI bleed Simulation/lecture A (48) 37.56±6.03 -0.81 .418
Lecture only B (46) 38.50±5.09
Knowledge for CS Simulation/lecture B (46) 7.30±1.99 -2.11 .038
Lecture only A (48) 6.29±2.64
Clinical reasoning for CS Simulation/lecture B (46) 7.57±1.67 -3.60 .001
Lecture only A (48) 6.29±1.76
Self-confidence for CS Simulation/lecture B (46) 38.13±6.55 1.10 .276
Lecture only A (48) 39.53±5.76

GI bleed=gastrointestinal bleed; CS=compartment syndrome.

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    Effects of Simulation on Nursing Students' Knowledge, Clinical Reasoning, and Self-confidence: A Quasi-experimental Study
    Korean J Adult Nurs. 2015;27(5):604-611.   Published online October 31, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.5.604
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    Effects of Simulation on Nursing Students' Knowledge, Clinical Reasoning, and Self-confidence: A Quasi-experimental Study
    Korean J Adult Nurs. 2015;27(5):604-611.   Published online October 31, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.5.604
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    Effects of Simulation on Nursing Students' Knowledge, Clinical Reasoning, and Self-confidence: A Quasi-experimental Study
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    Figure 1. Flowchart of the study.

    Figure 1.

    Effects of Simulation on Nursing Students' Knowledge, Clinical Reasoning, and Self-confidence: A Quasi-experimental Study

    Rubric for Evaluating the Clinical Reasoning Skill

    Categories   Score and description  
    Collecting data 3 Appropriately collects the subjective and objective data related to the patient' s condition 2 Collects the most obvious data, missing some important information 1 Confuses the patient's condition and disorganizes the data
    Diagnosing 2 Analyzes and synthesizes the data; describes the diagnosis relevant to data 1 Analyzes and synthesizes the data; describes the diagnosis but less relevant to data 0 Has difficulty analyzing and synthesizing the data; describes the diagnosis but not relevant to data
    Prioritizing problem 2 Focuses on the most relevant and important data to patient's condition 1 Focuses on data relevant to patient's condition but less important or not priority 0 Has difficulty with prioritizing; data not relevant to patient's condition
    Planning 3 Selects nursing interventions to resolve the problem; appropriately planned interventions based on relevant patient data 2 Selects nursing interventions to resolve the problem; less appropriately planned interventions based on most obvious data 1 Selects a single intervention, addressing a likely solution, but it may be vague, confusing, and/or incomplete

    Homogeneity of the Participants' Characteristics between the Groups (N=94)

    Characteristics Categories Group A (n=48) Group B (n=46) x2 or t p
    n (%) or M±SD n (%) or M±SD
    Gender Male 6 (12.5) 5 (10.9) 0.06 .806
    Female 42 (87.5) 41 (89.1)  
    Age (year)   21.06±1.80 20.98±1.35 0.26 .799
    Satisfaction for nursing major   3.60±0.71 3.50±0.86 0.64 .523
    Grade point average (GPA)   3.59±0.46 3.53±0.43 0.64 .523
    Self-confidence for GI bleed   33.09±5.44 32.60±5.75 0.46 .679
    Self-confidence for CS   33.90±5.60 33.33±7.54 0.41 .682

    GI bleed=gastrointestinal bleed; CS=compartment syndrome.

    Comparison of Knowledge, Clinical Reasoning, and Self-confidence between the Groups (N=94)

    Variables Categories Group (n) M±SD t p
    Knowledge for GI bleed Simulation/lecture A (48) 6.83±1.93 2.55 .012
    Lecture only B (46) 5.70±2.38
    Clinical reasoning for GI bleed Simulation/lecture A (48) 6.34±1.88 2.83 .006
    Lecture only B (46) 5.22±1.94
    Self-confidence for GI bleed Simulation/lecture A (48) 37.56±6.03 -0.81 .418
    Lecture only B (46) 38.50±5.09
    Knowledge for CS Simulation/lecture B (46) 7.30±1.99 -2.11 .038
    Lecture only A (48) 6.29±2.64
    Clinical reasoning for CS Simulation/lecture B (46) 7.57±1.67 -3.60 .001
    Lecture only A (48) 6.29±1.76
    Self-confidence for CS Simulation/lecture B (46) 38.13±6.55 1.10 .276
    Lecture only A (48) 39.53±5.76

    GI bleed=gastrointestinal bleed; CS=compartment syndrome.
    Table 1. Rubric for Evaluating the Clinical Reasoning Skill

    Table 2. Homogeneity of the Participants' Characteristics between the Groups (N=94)

    GI bleed=gastrointestinal bleed; CS=compartment syndrome.

    Table 3. Comparison of Knowledge, Clinical Reasoning, and Self-confidence between the Groups (N=94)

    GI bleed=gastrointestinal bleed; CS=compartment syndrome.

    Table 1.

    Table 2.

    Table 3.

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