Exploring How Simulation Design and Participant Characteristics Impact Novice Nurses' Clinical Judgement in Simulation-Based Learning Experiences

Abstract

Background: Novice nurses are graduating without adequate clinical judgment to care for patients’ increasingly complex health needs. Nursing programs frequently use simulation-based learning experiences (SBLE) to develop clinical judgment. However, the increased demand for SBLE has led nurse educators to modify simulation designs and assign novice nurses to either active or observer roles, thereby increasing simulation capacity. There is conflicting evidence related to the impact of role assignments on simulation outcomes. Cognitive load may explain differences in simulation outcomes of active versus observer participants. The purpose of this body of research was to examine how simulation design and participant characteristics impact novice nurses’ clinical judgment. Methods: Four analyses were performed. First, a scoping review described evidence presented in 28 articles related to simulation observers’ learning outcomes. Next, an integrative review synthesized evidence presented 20 studies related to measurement and cognitive load experienced in nursing simulation. Third, a descriptive, longitudinal study described the clinical judgment trajectory of novice nurses who observed eight expert modeling video simulations and responded to clinical judgment prompts. Finally, a descriptive study explained reliability, feasibility, and usability of scoring written reflections with the Lasater Clinical Judgment Rubric after asynchronous simulation. Participants were simulation naïve, junior, undergraduate students in their first medical-surgical course at a nursing school in the southwestern region of the United States. Results: The scoping review identified eight major learning outcomes of the observer role. The integrative review synthesized the literature about cognitive load as a possible mediator of simulation outcomes. Regardless of clinical judgment ability, we found observers develop clinical judgment after viewing expert modeling videos asynchronously, and we identified writing characteristics differentiating novice nurses’ knowledge, thinking, and approach according to clinical judgment ability categories. Finally, the Lasater Clinical Judgment Rubric was reliable, feasible, and usable to score novice nurses’ written reflection after asynchronous simulation. Conclusion: Our body of work highlights how simulation design and participant characteristics impact learning outcomes. This work highlights the importance of using reliable measures to evaluate participant outcomes. Together, this body of research informs nurse educators’ simulation design decisions which optimize learning and increase simulation program capacity.